qualitative research design introduction

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16.1 Introduction to Qualitative Research Design

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Qualitative inquiry reflects a rich diversity of approaches with which we can explore the world. These approaches originate from philosophical and theoretical traditions that offer different strategies for us to systematically examine social issues. The placement of this chapter presented challenges for us. In many respects, your choice of design type is central to your research study, and might very well be one of the first choices you make. Based on this, we had considered leading off our qualitative section with this chapter, thereby exposing you to a range of different types of designs. Obviously, we had second thoughts. We ended up putting it at the end because we realized that if we opened up with this part of the discussion, you really wouldn’t have the background information to help you make sense of some of the differences between the various designs. Throughout our exploration of qualitative design thus far, we have discussed a number of decision points for you to consider as you design your study. Each of these decisions ties into your research question and ultimately will also be informed by, and help to inform, your research design choice. Your design choice truly reflects how these design elements are being brought together to respond to your research question and tell the story of your findings.

As we discussed in Chapter 19 , qualitative research tends to flow in an iterative vein, suggesting that we are often engaged in a cyclical process. This is true in the design phase of your study as well. You may revisit preliminary plans and decide that you now want to make changes to more effectively address the way in which you understand your research question or to improve the quality of your overall design. Don’t beat yourself up for this, this is part of the creative process of research! There is no perfect design and you are much better served by being a dynamic and critical thinker during the design process, rather than rigidly adhering to the first idea that comes along. We will now explore six different qualitative designs. Each will just be a brief introduction to that particular type of research, including what the main purpose of that design is and some basic information about conducting research in that vein. If you are interested in creating a proposal using a particular design, a number of resources and example studies are provided for each category.

Below is a brief checklist and justification questions to help you think about consistency across your qualitative design. When you have finished this chapter, come back to this exercise and see if you can complete this as it applies to your proposal.

• If yes, explain why this is:
• If no, consider a quantitative approach, or revising your research question so it is a better fit.
• If no, explain why not, and what approach you might consider as an alternative:
• If you’re not yet sure about which design you might choose, review the ones discussed in this chapter and consider what the value/purpose of each of them is. Which one seems like the best match for your question? (if you still aren’t sure, it might be good to consult with your professor)

17.2 Case study

Learning objectives.

Learners will be able to…

• Begin to distinguish key features that are associated with case study design
• Determine when a case study design may be a good fit for a qualitative research study

What is the purpose of case study research?

We’ve already covered that qualitative research is often about developing a deep understanding of a topic from a relatively small sample, rather than a broader understanding from the many. This is especially true for case study research. Case studies are essentially a ‘deep dive’ into a very focused topic. Skeptics of qualitative research often discount the value in studying the experiences and understandings of individuals and small groups, arguing that this type of research produces little value because it doesn’t necessarily apply to a large number of people (i.e. produce generalizable findings ). Hopefully you recognize the positivist argument here. These folks are likely to be unimpressed with the narrow focus that a case study adopts, suggesting that the restricted purview of a case study has little value to the scientific community. However, interpretativist qualitative researchers would counter that by thoroughly studying people, interactions, events, and the context in which they occur, researchers uncover key information about human beings, social interactions, and the nature of society itself. Remember, from this interpretative philosophical orientation we are not looking for what is “true” for the many, but we are seeking to recognize and better understand the complexity of life and human experiences; the multiple truths of a few. Case studies can be excellent for this!

Part of the allure of case studies stem from their diversity. You might choose to study:

• Individuals , such as a client with a unique need or a social worker with a unique position
• Small Groups , such as a newly formed anti-bullying student task force at a school
• Population (usually relatively small),  such as the residents of a subsidized housing community that are losing their homes in a gentrifying area
• Events ,  such as a member of a senior center dying by suicide
• Process , such as a community organizing entity targeting a local ordinance allowing waste storage in a community with few socioeconomic resources

If we choose to utilize a case study design for our research, the use of theory can be incredibly helpful to guide and support our purpose throughout the research process. The Writing Center at Colorado State University offers a very helpful web resource for all aspects of case study development, and one page is specifically dedicated to theoretical application for case study development. They outline three general categories of theory: individual theories, organizational theories, and social theories, all of which case study researchers might draw from. These are especially helpful for us as social work researchers, who may focus on research across micro, meso, and macro environments (as evidenced in the aforementioned case study examples). For instance, if you are the researcher in the last example, looking at community members challenging a local ordinance, you might draw on Community Organizing Theory and Capabilities Perspective to structure your study. As an alternative, if you are studying the experience of the first Black woman board president of a national organization, you might borrow from Minority Stress and Strengths Perspective as models as you develop your inquiry. Whatever your focus, theory can be an important tool to aid in orienting and directing your work.

What is involved with case study research?

Due to the diversity of topics studied and types of case study design, no two case studies look alike (just like snowflakes). For this reason, I’m going to focus this section on some common hallmarks of case studies that will hopefully help you as you think about designing and consuming case study research.

As the name implies, our emphasis with case study research is to provide an understanding of a specific case. The range of what qualifies as a case is extensive, but regardless, we are primarily aiming to explore and describe what is going on in the given case we are studying. As case study researchers, this means we need to work hard to gather rich details. We aren’t satisfied with surface, generic overviews or summaries, as these won’t provide the multidimensional understanding we are hoping for. Thinking back to our chapter on qualitative rigor, a case study researcher might aim to produce a thick description with the details they gather as a sign of rigor in their work. To gather these details, we need to be open to subtleties and nuances about our topic. If we are expending the energy to study a case in this level of detail, the research assumptions are that the case could provide valuable information and that we currently know relatively little about this case. As such, we don’t want to assume that we know what we are looking for. This means that we need to build in ways to capture unanticipated data and check our own assumptions as we design and conduct our study. We might use tools like reflexive journaling and peer debriefing to support rigor in this area.

Another good way to demonstrate both rigor and cultural humility when using this approach is engage stakeholders actively throughout the research process who are intimately involved with the case. This demonstrates good research practice in at least two ways. It potentially helps you to gather relevant and more meaningful data about the case, as a person who is connected to the case will likely know what to look for and where. Secondly, and more importantly, it reflects transparency and respect for the subjects of the case you are studying.

Another key feature of most case studies is that they don’t rely on one source of data. Again, returning to our exploration of qualitative rigor, triangulation is a very important concept for case study research. Because our target is relatively narrow in case study design, we often try to approach understanding it from many different angles. As a metaphor, you might think of developing a 360° view of your case. What level of dimensionality can you introduce by looking at different types of data or different perspectives on the issue you are studying? While other types of qualitative research may rely solely on data collected from one method, such as interviews, case studies traditionally require multiple. So, in the example above where you are studying the residents of a subsidized housing community that are losing their homes in a gentrifying area, you might decide to gather data by:

• Conducting interviews with residents
• Making observations in the community
• Attending community meetings
• Conducting key informant interviews with clergy, educators, human service providers, librarians, historians, and local politicians who serve the area
• Examining correspondence that community members share with you about the impending changes
• Examining media coverage about the impending changes

Furthermore, if you are invested in engaging stakeholders as discussed above, you could form a resident advisory group that would help to oversee the research process in its entirety. Ideally this group would have input into how results are shared and what they would hope to gain as a result of the study (i.e. what kind of change would they like to see come from this).

Case studies can often draw out the creativity in us as we consider the range of sources we may want to tap for data on our case. Of course, this creativity comes at a price, in that we invite the challenge of designing research protocols for all these different methods of data collection and address them thoroughly in our IRB applications! Finally, with the level of detail and variety of data sources we have already discussed, case studies endeavor to pay attention to and provide a good accounting of context . If we are working to provide a rich, thick description of our case, we need to offer our audience information about the context in which our case exists. This can mean that we collect data on a range of things that might include:

• the socio-polticial environment surrounding our case
• the background or historical information that preceded our case
• the demographic information that helps to describe the local community that our case exists in

As you consider what contextual information you plan to gather and share, stay fluid. Again, it is likely that we won’t know in advance the many contextual features that are reflected in our case. If you are doing a good job listening to your participants and engaging stakeholder in your process, they will tell you what is important to note. As social workers, we draw on a person-in-environment approach to help us conceptualize the ways in which our clients interact with the world around them and the challenges they encounter. Similarly, as researchers, we want to conceptualize case study-in-environment as we are developing our case study projects.

Key Takeaways

• Case studies offer an effective qualitative design when seeking to describe or understand a very specific phenomenon in great detail. The focus of a “case” can cover a range of different topics, including a person, a group, an event or a process.
• The design of a case study usually involves capturing multiple sources of data to help generate a rich understanding of both the content and the context of the case.

Based on your social work passions and interests:

• What is a specific topic you feel might be well-suited for a case study?
• What potential sources of data would you use for your case study?
• What sorts of contextual information would you want to make sure to search for to get a really comprehensive understanding of your case?

To learn more about case study research

Baxter, P., & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researchers .

Gibbs, G.R. (2012, October, 24). Types of case studies: Part 1 of 3 on case studies .

Gibbs, G.R. (2012, October, 24). Planning a case study: Part 2 of 3 on case studies .

Gibbs, G.R. (2012, October, 24). Replication or single cases: Part 3 of 3 on case studies .

Harrison et al. (2017). Case study research: Foundations and methodological orientations .

Hyett et al. (2014). Methodology or method? A critical review of qualitative case study reports .

Lock, I., & Seele, P. (2018). Gauging the rigor of qualitative case studies in comparative lobbying research. A framework and guideline for research and analysis .

Stake, R. E. (1995).  The art of case study research . Thousand Oaks, CA: Sage publications.

Starman, A. B. (2013). The case study as a type of qualitative research .

Writing@CSU, the Writing Studio: Colorado State University (n.d.). Case studies .

Yin, R. K. (2014). Case study research and applications: Design and methods . Thousand Oaks, CA: Sage publications.

For examples of case study research

Chan, C., & Holosko, M. J. (2017). The utilization of social media for youth outreach engagement: A case study .

Gabriel, M. G. (2019). Christian faith in the immigration and acculturation experiences of Filipino American youth .

Paddock et al. (2018). Care home life and identity: A qualitative case study .

21.2 Constructivist

• Begin to distinguish key features that are associated with constructivist design
• Determine when a constructivist design may be a good fit for a qualitative research study

What is the purpose of constructivist research?

Constructivist research seeks to develop a deep understanding of the meaning that people attach to events, experiences, or phenomena. It draws heavily from the idea that our realities are constructed through shared social interaction, within which each person holds a unique perspective that is anchored in their own position (where they are situated in the world) and their evolving life experiences to date. Constructivist research then seeks to bring together unique individual perspectives around a common topic or idea (the basis of the research question), to determine what a shared understanding for this particular group of participants might be. By developing a common or shared understanding, we are better able to appreciate the multiple sides or facets of any given topic, helping us to better appreciate the richness of the world around us. You can think about constructivist research as being akin to cultural humility. When we approach practice with a sense of cultural humility, we assume that people who participate in a shared culture experience it from their own unique perspective. As we work with them, we try our best to understand and respect their personal understanding of that culture. Similarly, in constructivist research, we attempt to bring together (and honor) these unique individual perspectives on a given topic and construct a shared understanding, attempting to take what might be one-dimensional and making it multidimensional.

Constructivist research, as a method of inquiry, originated out of the work of Lincoln and Guba (1985), [1] although it was initially termed “naturalism”. In stark contrast to more positivist research traditions that make the assumption that the broad aim of research as an approach to knowledge building is to produce generalizable findings, constructivist research assumes that any knowledge produced through the research process is context-dependent . This means that constructivist findings are specific to those who contributed to that knowledge building and the situation in which it took place. That isn’t to say that these results might not have broader value or application, but the aim of the constructivist researcher is not to make that claim. The aim of the constructivist design is to provide a rich, full, detailed account of both the research process and the research findings. This inlcudes a detailed description of the context in which the research is taking place. In this way, the research consumer can determine the value and application of the research findings. The video by Robertson (2007) [2] in the resources box offers a good overview of this methodology and many of the assumptions that underlie this approach .

If you are a researcher considering a constructivist design, Rodwell (1998) [3] suggests that you should consider the focus, fit, and feasibility of your study for this particular methodology. While she provides a very helpful discussion across all three areas, her attention to ‘fit’ for constructivist inquiry is perhaps most relevant for our abbreviated overview of this methodology. In her discussion of ‘fit’, Rodwell argues that research questions well-suited for constructivist research are:

• Multi-dimensional:  meaning that multiple constructions or understandings of the “reality” of the topic are being sought
• Investigator interactive:  meaning that the topic is susceptible to researcher influence by virtue of the researcher having to be very involved in data collection and therefore accountable for considering their role in the knowledge production process
• Context-dependent:  meaning that the circumstances surrounding the participants and the research process must be taken into account
• Complex: meaning we should assume there are multiple causes that contribute to the problem under investigation (and that the research is seeking to explore, rather than collapse that complexity)
• Value-laden:  meaning that the topic we are studying is best understood in a way that accounts for the diverse values and opinions people attach to it.

What is involved with constructivist research?

As you may have surmised from the discussion above, the cornerstone of constructivist research is the researcher engaging in immersive exchanges with participants in an effort to ‘construct’ the meaning that they attach to the topic being studied.

Again, drawing on Rodwell’s (1998) [4] description of this methodology, a constructivist researcher needs to recruit a [pb_glossaryid=”918″] purposive [/pb_glossary] sample that has unique and diverse first-hand knowledge of the topic being studied. They will gather data from this sample regarding their respective realities or understandings of the topic. They will attempt to account for the context in which the study is taking place (including the researcher’s own influence as a human instrument ). Throughout the analysis process they will work towards producing negotiated outcomes , taking time to clarify and verify that findings accurately capture the sentiment of participants; treating participants as experts in their own reality. Finally, they will bring this knowledge together in a way that attempts to reflect the complex and multidimensional understandings of the topic being studied.

Constructivist research findings are well-suited for being presented as a case report. This allows for many realities or understandings of a given topic to be constructed. When you think about the value of constructivist research for social work, review some of the research articles listed below as examples. Envision using the findings from Allen’s (2011) [5] study about women’s resistance to abuse to help us improve shelter-based intervention and public health prevention efforts. Also, as a manager in an older adult care facility, you could use Cook and Brown-Wilson’s (2011) [6] work focused on nursing home residents and their social relationships with staff to help inform ongoing staff training efforts that are more centered in nurturing social connections.

• Constructivist studies are well suited to develop a rich, multidimensional understanding of a topic through the extensive study of the experience of that topic across multiple observers. The individual realities experienced by participants are brought together to developed a shared, constructed understanding.
• The end result of a constructivist research project should help the consumer to see the phenomenon being studied from many different perspectives and with an appreciation of its complexity and nuance.

To learn more about constructivist research

Drisko, J. W. (2013). Constructivist research in social work. In A. E. Fortune, W. J. Reid, & R. L. Miller, Jr. (Eds.), Qualitative research in social work (2nd ed.), (pp. 81-106). New York : Columbia University Press.

Lincoln, Y. S., & Guba, E. G. (2013). The constructivist credo . Walnut Creek, CA: Left Coast Press, Inc.

Mojtahed et al. (2014). Equipping the constructivist researcher: The combined use of semi-structured interviews and decision-making maps .

Robertson, I. (2007, May 13). Naturalistic or constructivist inquiry .

Rodwell, M. K. (1998). Social work constructivist research . New York: Routledge

Stewart, D. L. (2010). Researcher as instrument: Understanding” shifting” findings in constructivist research .

For examples of constructivist research

Allen, M. (2011). Violence and voice: Using a feminist constructivist grounded theory to explore women’s resistance to abuse .

Coleman et al. (2012). A constructivist study of trust in the new s.

Cook, G., & Brown-Wilson, C. (2010). Care home residents’ experiences of social relationships with staff .

Leichtentritt et al. (2011). Construction of court petitions in cases of alternative placement of children at risk: Meaning‐making strategies that social workers use to shape court decisions .

O’Callaghan et al. (2012). Music’s relevance for adolescents and young adults with cancer: A constructivist research approach .

21.3 Oral history

• Begin to distinguish key features that are associated with oral history design
• Determine when an oral history design may be a good fit for a qualitative research study

What is the purpose of oral history research?

As outlined by the Oral History Association (OHA, 2009), “Oral history interviews seek an in-depth account of personal experience and reflections, with sufficient time allowed for the narrators (interviewees) to give their story the fullness they desire. The content of oral history interviews is grounded in reflections on the past as opposed to commentary on purely contemporary events”. [7] Much like case studies with their intentionally narrow focus, oral histories are dedicated to developing a deep understanding with a relatively limited scope. This may include a single oral history provided by one interviewee, or a series of oral histories that are offered around a unifying topic, event, experience or shared characteristic.

Now, what makes this a form of research and not just a venue for sharing stories (valuable in-and-of-itself), is that these stories are connected systematically and there is a central question or series of questions that we as researchers are attempting to answer. For instance, the Columbia Center for Oral History Research at Incite hosts the Human Rights Campaign Oral History Project. This project seeks to understand: “What can a single organization tell us about a social movement and social change? How do historic moments shape organizations and vice versa? How do institutions with diverse constituencies reconcile competing needs and agendas for a forward-thinking movement, all while effectively responding to consistent external attacks?” [8] By interviewing people connected with this organization and its work, this oral history project is simultaneously hoping to gain a rich understanding of the Human Rights Campaign (HRC), but also an appreciation of how social change may occur more broadly, with HRC as an instructive example.

Particularity relevant for social work research, oral histories are often used for the purpose of studying and promoting social change, as in the HRC example. For instance, Groundswell is a network of “oral historians, activists, cultural workers, community organizers, and documentary artists” dedicated to the use of oral history as a tool for social change. [9] The central idea here is that by sharing our stories, we can learn from each other. Much like in narrative therapy traditions, our stories contain valuable and transformative information. In the case of narrative therapy, the narrative is transformative for the individual, but in the case of oral histories, the hope is that these shared narratives are transformative for the audience by offering new perspectives on the world, what it needs, and what it offers. Ideally this transformation leads to action and broader social change.

What is involved in oral history research?

While the core of oral history research involves interviewing people to capture their historical accounts to help explore a broader question or set of questions, the research process is a bit more involved than this. Moyer (1999) [10] offers an overview of the steps involved in conducting oral history research.

• Formulate a central question, set of questions, or issue
• Plan the project. Consider such things as end products, budget, publicity, evaluation, personnel, equipment, and time frames.
• Conduct background research
• Process interviews
• Evaluate research and interviews and cycle back to step 1 if the central question is not sufficiently answered, or go on to step 7 if it is
• Organize and present results
• Store materials archivally

Of course, these are generic steps and only a beginning introduction to oral history design. Each of these steps has its own learning curve and nuance. For instance, interviewing for oral histories can vary in both preparation and application when compared to interviewing for other forms of qualitative research. Resources for further learning on oral history research are offered at the end of this section to help you become more knowledgeable and proficient. In addition to this overview of the design process, there are a number of unique principles associated with conducting oral histories. Let’s discuss a few of these.

Oral history as a relationship between the interviewer and interviewee

Just as with other forms of interviewing, the expectation is the participation is voluntary and only proceeds after informed consent is provided. While this is very important for all research, it is perhaps especially important for oral histories because of some of the aspects discussed below (e.g. public access, frequent disclosure of identifying information) that differentiate oral histories. [11] [12] Thoroughly explaining what oral histories are, how they are conducted, and the nature of the research final products is especially important. In addition, interviewees for oral histories often have a greater degree of control in their storytelling , with less direction from the interviewer (compared with other forms of qualitative interviewing). [13] [14] This potentially challenges some of the power dynamics in more traditional research traditions. While the interviewer does provide the initial prompt or question and hopes to obtain an in-depth account, the interviewee is largely in control of how the story is told.

Oral history as a research product

Consistent with our NASW code of ethics and the expectations of all qualitative researchers, interviewees should be treated with dignity and respect. For the purposes of oral history research, this is in part demonstrated through crafting significant historical questions and engaging in prior research and preparation to inform the study (generally) and the interview (specifically). [15] [16] . This will lay the foundation for a well-informed oral history project. The oral history is a detailed historical recounting by one person or a small group of people. It is meant to be a ‘window in time’ through the lens of the interviewee. [17] Because an oral history involves the detailed telling of personal stories and experiences it is often expected that the finished products of oral histories will often provide identifying information; it is often unavoidable in recounting the history. In fact, the interviewee is typically identified by name due to the extensive detail and contextually identifying information that is gathered. [18] [19] Again, this should be made abundantly clear during the recruitment process and spelled out in the informed consent.

Oral history as an ongoing commitment

Traditional research is often shared with the public through journal articles or conference proceedings, and these often do not provide access to the data. While oral history research may be shared in these venues, the expectation is generally that oral history interviews that are collected will also be made accessible to future researchers and the public. [20] To accommodate this, researchers need to be planful in how they will provide this access in a sustainable way. This also means they need to have access to and operating knowledge of technology that will allow for quality audio capture and maintenance of these oral histories. [21] [22] Furthermore, this obligation needs to be very clear to participants before they share their hisitories. Also, because of the level of access that is often afforded to oral history interviews, researchers can’t guarantee how others may use or portray these interviews in the future and should be mindful not to overpromise such guarantees to participants.

Cultural considerations with storytelling

I think it is also important for us to consider the cultural implications of storytelling and the connection this holds for oral history research. Many cultural groups have and continue to depend on storytelling as a means of transmitting culture through time and space. Lately, I have been thinking about this as a response to the racial conflict we have been experiencing in the United States. It can be particularly powerful to hear the stories of others and to allow ourselves to be changed by them. The author Ta-Nehisi Coates book Between the World and Me is a profound nonfiction work that is written as a letter to his teenage son about what it means to be a Black man in America, drawing on his own memories, experiences and observations. In addition, Takunda Muzondiwa , offers a beautifully articulated performance of spoken word poetry about her history as a young woman immigrating from Zimbabwe to New Zealand. I believe these stories can be powerful antidotes to the fear and ignorance that fuels so much of the structural oppression and racial division in this country. Gathering oral histories can help contribute to elevating these voices and hopefully promoting understanding. However, I think we also have to be very aware of the danger in this practice of cultural appropriation. It requires us to be extremely vigilant in how these stories are obtained and presented, and who has ownership of them.

• Oral histories offer a unique qualitative research design that support an individual or group of participants reflecting on a unique experience, event, series of events, or even a lifetime. While they explicitly explore the past, they often do so to learn about how change occurs and what lessons can be applied to our present.
• While many aspects of oral histories are consistent with other forms of qualitative research (e.g. the use of interviews to collect data, analyzing narrative data for themes), oral histories have some defining features that differentiate it from other designs, such as a common expectation for public access to collected data.

Reflexive Journal Entry Prompt

For me, oral history has a bit of a different feel when compared to other qualitative designs because it really highlights intimate details of one person’s (or a small group) life. in a way that makes confidentiality a real challenge in many cases (or even impossible). That being said, I’m also really drawn to the potential of this approach for allowing people to share wisdom and for us to learn from each other.

Based on what you have read here and maybe after checking out some of the resources below, what are your thoughts about using oral histories?

• What do you see as strengths?
• What are barriers or challenges that you foresee?
• What oral history data might help to strengthen or develop your practice knowledge? (whose wisdom and historical perspective might you learn from)

To learn more about oral histories and oral history archives

Columbia University, Interdisciplinary Center for Innovative Theory and Empirics (n.d.) Columbia Center for Oral History Research at INCITE.

Groundswell. (2014). Groundswell: Oral history for social change .

Institute for Museum and Library Services. (n.d.). Oral history in the digital age .

International Oral History Association. (n.d.). International Oral History Association, homepage .

Moyer, J. (1999). Step-by-step guide to oral history .

Oral History Association (2009, October). Principles and best practices .

UCLA (2015). UCLA Center for Oral History Research .

For examples of oral history research

Gardella, L. G. (2018). Social work and hospitality: An oral history of Edith Stolzenberg .

Jenkins, S. B. (2017). “We were all kind of learning together” The emergence of LGBTQ+ affirmative psychotherapy & social services, 1960-1987: oral history study . 

Johnston et al. (2018). The rise, fall and re-establishment of Trinity Health Services: Oral history of a student-run clinic based at an inner-city Catholic Church .

La Rose, T. (2019). Rediscovering social work leaders through YouTube as archive: The CASW oral history project 1983/1984 .

21.4 Ethnography

• Distinguish between key features associated with ethnographic design
• Determine when an ethnographic design may be a good fit for a qualitative research study

What is the purpose of ethnography research?

Ethnography is a qualitative research design that is used when we are attempting to learn about a culture by observing people in their natural environment. While many immediately associate culture with ethnicity, remember that cultures are all around us, and we exist in many simultaneously. For example, you might have a culture within your family, at your school, at work, as part of other organizations or groups that you belong to. Culture exists where we have a social grouping that creates shared understanding, meaning, customs, artifacts, rituals, and processes.

Cultural groups can exist in-person and in virtual spaces. Culture challenges us to consider how people understand and dynamically interact with their environment. Creswell (2013) outlines the role of the ethnographer as, “describing and interpreting the shared and learned patterns of values, behaviors, beliefs and languages of culture-sharing groups” (p.90). [23] Below is a brief list of areas where we may find “culture-sharing groups”.

• Peer Groups
• Support Groups
• Cause-Related Groups
• Organizations
• Interest-Related Groups

Respond to the following questions.

• What cultures do you participate in?
• What cultures might the clients you work with in your field placements participate in?
• What cultures might the participants you are interested in studying participate in? 

Reflecting on this question can help us to see ourselves and our clients or our research participants as multidimensional people and to develop solid research proposals.

Now that we have discussed what culture is, why is it important that we research it? More specifically, why is it important that we have ethnography, a type of qualitative research dedicated to studying culture? As social work practitioners and educators, we talk extensively about concepts like cultural competence and cultural humility. As a profession, we have taken the position that understanding culture is vital to what we do. Ideologically, Social Work recognizes that people have very different experiences throughout their lives. Some of these experiences are shared and can come to shape the perspective of groups of people, and in turn, how these groups interact with the world around them and with each other. By studying these shared perspectives, ethnographers hope to learn both how groups of people are shaped by and come to shape their environment (this is the definition of a fancy term, reciprocal determinism ). Ethnographic research can be one source of information that helps support culturally informed social work practice. Note that I specifically said one source. As an ethnographer, we are typically an “outsider” observing and learning about a culture. As practitioners, we should  also   be educated about culture directly from our clients because they have “insider” knowledge. Both are valuable and can be helpful for the work we do, but I would argue that we give priority to our client’s perspective, as they are an authority on their experience of culture.

As you think about the value of ethnographic research, it can also be helpful to think about what types of things we might learn from it. Let’s take a specific example. What if we wanted to study the culture around a student study group. What are some of the things we might hope to learn by examining the culture of this group?

• What motivates them to participate in the group?
• What are their expectations about the group?
• What do they hope to get out of the group?
• What are the group norms?
• What are the formal and informal roles of the group?
• What functions does the group serve?
• What types of group dynamics are evident?
• What influence external to the group impact the group, and how?

What is involved with ethnography research?

As a process of uncovering and making sense of a culture, ethnographic research involves the researcher immersing themselves in the culture to gain direct and indirect information through keen observation, discussion with culture-sharing members, and review of cultural artifacts. To accomplish this successfully, the ethnographer will need to spend extensive time in the field, both to gather enough data to comprehensively describe the culture, and to gain a reasonable understanding of the context in which the culture takes place so that they can interpret the data as accurately as possible. Hammersley (1990) [24] outlines some general guidelines for conducting ethnographic research.

Data is drawn from a range of sources

While data gathering is systematic, it is emergent and begins with a loose structure, parameters are usually placed on the setting(s) from which data is gathered, observing behavior in everyday life, analysis involves the interpretation of human behavior and making sense out of the actions of the culture group.

Below I provide some additional details around each of these principles to help contextualize how these might compare and contrast with other qualitative designs we have been discussing.

Since our objective is to understand a culture as comprehensively as possible, ethnographies require multiple sources of data. If someone wanted to study the culture within your social work program, what sorts of data might they utilize? They might include discussions with students, staff, and faculty; observations of classes, functions, and meetings; review of documents like mission statements, annual reports, and course evaluations. These are only a small sampling of data sources that you might include to gain the most holistic understanding of the program.

While some qualitative studies begin with an extensive and detailed plan for data gathering, ethnographies begin with a considerable amount of flexibility. This is because we often don’t know in advance what will be important in developing an understanding of a culture and where that information might come from. As such, we would need to spend time in the culture, being attentive and open to learning from the context.

Culture can extend across space and time, making it overwhelming as we initially consider how to focus our efforts while still allowing for the emergent design discussed above. Because of this, ethnographies are often confined to one particular setting or group. I don’t know if any of you are fans of the TV series The Office (either the British or American versions), but it actually offers us a good example here. The series is based on following the antics that take place in office environment with a group of co-workers through a mockumentary . The series is about understanding the culture of that office. The majority of filming takes place in a small office and with a relatively small group of people. These parameters help to define the storyline, or for our purposes, the scope of our data gathering.

Compared to other qualitative approaches where data gathering may take place through a more formal process (e.g. scheduled interviews, routine observations of specified exchange), ethnographies usually involve collecting data in everyday life. To capture an authentic representation of culture, we need to see it in action. Thus, we need to be prepared to gather data about culture as it is being produced and experienced.

Related to the last point about observing behavior in everyday life, culture is created and transmitted through social interactions. As ethnographers, the main thrust of our work is to observe and interpret how people engage with each other, and what these interactions mean.

As I mentioned in the oral history section, I think we also need to be really attentive to the possibility of cultural appropriation and exploitation when conducting ethnographies. This is really true for all types of research, but it deserves special attention here because of the duration of time ethnography requires immersing yourself in the culture you are studying. It makes me think of my time as a case manager. As a case manager, I think we need to be acutely aware of demonstrating great respect and humility when we are working with people in their homes. We are entering into a very personal space with them to conduct our work and I believe that it requires special care and attention. Ethnography work is much like this. As an ethnographer, you are attempting to enter into the very personal space of that cultural group. Before doing so, as researchers, I think we need to very carefully consider what benefits does this study offer. If the only answer is that we benefit professionally or academically, then is it really worth it for us to be so intrusive? Of course, actively including community members in the research process and allowing them to help determine the benefits they hope to recognize from such a study can be a good way to overcome this.

• Ethnographic studies allow researchers to experience and describe a culture by immersing themselves within a culture-sharing group.
• Ethnographic research requires that researchers be attentive observers and curious explorers as they spend extensive time in the field viewing cultural rituals and artifacts, speaking with cultural group members, and participating in cultural practices. This requires spending extensive time with this group to understand the nuances and intricacies of cultural phenomenon.

To learn more about ethnography research

Genzuk, M. (2003). A synthesis of ethnographic research .

Isaacs, E., TEDxBroadway. (2013, January, 28). “Ethnography”—Ellen Isaacs .

Wall, S. (2015, January). Focused ethnography: A methodological adaptation for social research in emerging contexts .

Reeves et al. (2013). Ethnography in qualitative educational research: AMEE Guide No. 80 .

Sangasubana, N. (2011). How to conduct ethnographic research .  

For examples of ethnography research

Avby et al. (2017). Knowledge use and learning in everyday social work practice: A study in child investigation work .

Hicks, S., & Lewis, C. (2018). Investigating everyday life in a modernist public housing scheme: The implications of residents’ understandings of well-being and welfare for social work .

Lumsden, K., & Black, A. (2017). Austerity policing, emotional labour and the boundaries of police work: an ethnography of a police force control room in England .

21.5 Phenomenology

• Begin to distinguish key features that are associated with phenomenological design
• Determine when a phenomenological study design may be a good fit for a qualitative research study

What is the purpose of phenomenology research?

Phenomenology is concerned with capturing and describing the lived experience of some event or “phenomenon” for a group of people. One of the major assumptions in this vein of research is that we all experience and interpret our encounters with the world around us. Furthermore, we interpret these experiences from our own unique worldview, shaped by our beliefs, values and previous encounters. We then go on to attach our own meaning to them. By studying the meaning that people attach to their experiences, phenomenologists hope to understand these experiences in much richer detail. Ideally, this allows them to translate a unidimensional idea that they are studying into a multidimensional understanding that reflects the complex and dynamic ways we experience and interpret our world.

As an example, perhaps we want to study the experience of being a student in a social work research class, something you might have some first-hand knowledge with. Putting yourself into the role of a participant in this study, each of you has a unique perspective coming into the class. Maybe some of you are excited by school and find classes enjoyable; others may find classes boring. Some may find learning challenging, especially with traditional instructional methods; while others find it easy to digest materials and understand new ideas. You may have heard from your friends, who took this class last year, that research is hard and the professor is evil; while the student sitting next to you has a mother who is a researcher and they are looking forward to developing a better understanding of what she does. The lens through which you interpret your experiences in the class will likely shape the meaning you attach to it, and no two students will have the exact same experience, even though you all share in the phenomenon—the class itself. As a phenomenologist, I would want to try to capture how various students experienced the class. I might explore topics like: what did you think about the class, what feelings were associated with the class as a whole or different aspects of the class, what aspects of the class impacted you and how, etc. I would likely find similarities and differences across your accounts and I would seek to bring these together as themes to help more fully understand the phenomenon of being a student in a social work research class. From a more professionally practical standpoint, I would challenge you to think about your current or future clients. Which of their experiences might it be helpful for you to better understand as you are delivering services? Here are some general examples of phenomenological questions that might apply to your work:

• What does it mean to be part of an organization or a movement?
• What is it like to ask for help or seek services?
• What is it like to live with a chronic disease or condition?
• What do people go through when they experience discrimination based on some characteristic or ascribed status?

Just to recap, phenomenology assumes that…

• Each person has a unique worldview, shaped by their life experiences
• This worldview is the lens through which that person interprets and makes meaning of new phenomena or experiences
• By researching the meaning that people attach to a phenomenon and bringing individual perspectives together, we can potentially arrive at a shared understanding of that phenomenon that has more depth, detail and nuance than any one of us could possess individually.

Figure 21.2 provides a visual interpretation of these assumptions.

What is involved in phenomenology research?

Again, phenomenological studies are best suited for research questions that center around understanding a number of different peoples’ experiences of particular event or condition, and the understanding that they attach to it. As such, the process of phenomenological research involves gathering, comparing, and synthesizing these subjective experiences into one more comprehensive description of the phenomenon. After reading the results of a phenomenological study, a person should walk away with a broader, more nuanced understanding of what the lived experience of the phenomenon is.

While it isn’t a hard and fast rule, you are most likely to use purposive sampling to recruit your sample for a phenomenological project. The logic behind this sampling method is pretty straightforward since you want to recruit people that have had a specific experience or been exposed to a particular phenomenon, you will intentionally or purposefully be reaching out to people that you know have had this experience. Furthermore, you may want to capture the perspectives of people with different worldviews on your topic to support developing the richest understanding of the phenomenon. Your goal is to target a range of people in your recruitment because of their unique perspectives.

For instance, let’s say that you are interested in studying the subjective experience of having a diagnosis of Human Immunodeficiency Virus (HIV). We might imagine that this experience would be quite different across time periods (e.g. the 1980’s vs. the 2010’s), geographic locations (e.g. New York City vs. the Kingdom of Eswatini in southern Africa), and social group (e.g. Conservative Christian church leaders in the southern US vs. sex workers in Brazil). By using purposive sampling, we are attempting to intentionally generate a varied and diverse group of participants who all have a lived experience of the same phenomenon. Of course, a purposive recruitment approach assumes that we have a working knowledge of who has encountered the phenomenon we are studying. If we don’t have this knowledge, we may need to use other non-probability approaches, like convenience or snowball sampling. Depending on the topic you are studying and the diversity you are attempting to capture, Creswell (2013) suggests that a reasonable sample size may range from 3 -25 participants for a phenomenological study. Regardless of which sample size you choose, you will want a clear rationale that supports why you chose it.

Most often, phenomenological studies rely on interviewing. Again, the logic here is pretty clear—if we are attempting to gather people’s understanding of a certain experience, the most direct way is to ask them. We may start with relatively unstructured questions: “can you tell me about your experience with…..”, “what was it it like to….”, “what does it mean to…”. However, as our interview progresses, we are likely to develop probes and additional questions, leading to a semi-structured feel, as we seek to better understand the emerging dimensions of the topic that we are studying. Phenomenology embodies the iterative process that has been discussed; as we begin to analyze the data and detect new concept or ideas, we will integrate that into our continuing efforts at collecting new data. So let’s say that we have conducted a couple of interviews and begin coding our data. Based on these codes, we decide to add new probes to our interview guide because we want to see if future interviewees also incorporate these ideas into how they understand the phenomenon. Also, let’s say that in our tenth interview a new idea is shared by the participant. As part of this iterative process, we may go back to previous interviewees to get their thoughts about this new idea. It is not uncommon in phenomenological studies to interview participants more than once. Of course, other types of data (e.g. observations, focus groups, artifacts) are not precluded from phenomenological research, but interviewing tends to be the mainstay.

In a general sense, phenomenological data analysis is about bringing together the individual accounts of the phenomenon (most often interview transcripts) and searching for themes across these accounts to capture the essence or description of the phenomenon. This description should be one that reflects a shared understanding as well as the context in which that understanding exists. This essence will be the end result of your analysis.

To arrive at this essence, different phenomenological traditions have emerged to guide data analysis, including approaches advanced by van Manen (2016) [25] , Moustakas (1994) [26] , Polikinghorne (1989) [27] and Giorgi (2009) [28] . One of the main differences between these models is how the researcher accounts for and utilizes their influence during the research process. Just like participants, it is expected in phenomenological traditions that the researcher also possesses their own worldview. The researcher’s worldview influences all aspects of the research process and phenomenology generally encourages the researcher to account for this influence. This may be done through activities like reflexive journaling (discussed in Chapter 20 on qualitative rigor) or through bracketing (discussed in Chapter 19 on qualitative analysis), both tools helping researchers capture their own thoughts and reactions towards the data and its emerging meaning. Some of these phenomenological approaches suggest that we work to integrate the researcher’s perspective into the analysis process, like van Manen; while others suggest that we need to identify our influence so that we can set it aside as best as possible, like Moustakas (Creswell, 2013). [29] For a more detailed understanding of these approaches, please refer to the resources listed for these authors in the box below.

• Phenomenology is a qualitative research tradition that seeks to capture the lived experience of some social phenomenon across some group of participants who have direct, first-hand experience with it.
• As a phenomenological researcher, you will need to bring together individual experiences with the topic being studied, including your own, and weave them together into a shared understanding that captures the “essence” of the phenomenon for all participants.
• As you think about the areas of social work that you are interested in, what life experiences do you need to learn more about to help develop your empathy and humility as a social work practitioner in this field of practice?

To learn more about phenomenological research

Errasti‐Ibarrondo et al. (2018). Conducting phenomenological research: Rationalizing the methods and rigour of the phenomenology of practice .

Giorgi, A. (2009).  The descriptive phenomenological method in psychology: A modified Husserlian approach . Pittsburgh, PA: Duquesne University Press.

Koopman, O. (2015). Phenomenology as a potential methodology for subjective knowing in science education research .

Moustakas, C. (1994).  Phenomenological research methods.  Thousand Oaks, CA: Sage.

Newberry, A. M. (2012). Social work and hermeneutic phenomenology .

Polkinghorne, D. E. (1989). Phenomenological research methods. In R. S. Valle & S. Halling (Eds.). Existential-phenomenological perspectives in psychology (pp. 41-60). Boston, MA: Springer.

Seymour, T. (2019, January, 30). Phenomenological qualitative research design .

Van Manen, M. (2016).  Phenomenology of practice: Meaning-giving methods in phenomenological research and writing . New York: Routledge.

For examples of phenomenological research

Curran et al. (2017). Practicing maternal virtues prematurely: The phenomenology of maternal identity in medically high-risk pregnancy .

Kang, S. K., & Kim, E. H. (2014). A phenomenological study of the lived experiences of Koreans with mental illness .

Pascal, J. (2010). Phenomenology as a research method for social work contexts: Understanding the lived experience of cancer survival .

21.6 Narrative

• Begin to distinguish key features associated with narrative design
• Determine when a narrative design may be a good fit for a qualitative research study

What is the purpose of narrative research?

As you savvy learners have likely surmised, narrative research, often referred to as narrative inquiry, is all about the narrative. For our purposes, narratives will be defined as those stories that we compose that allow us to make meaning of the world. Therefore, narrative inquiry is attempting to develop a rich understanding of what those narratives are, and weave them into a grander narrative that attempts to capture the unique and shared meanings we attach to our individual narratives. In other words, as narrative researchers, we want to understand how we make sense of what happens to us and around us.

As social workers, our profession is well-acquainted with the power of narratives. Michael White and David Epston are social workers you may know of that harnessed this power of narratives in the therapeutic relationship by helping clients to tell and then transform their many-storied lives through narrative therapy. Just as narrative therapy encourages clients to explore the stories in their own lives and the significance they attach to them, narrative inquiry prompts research participants to share the stories they have regarding the topic we are studying. Just as we discussed in our chapter on qualitative data gathering, our aim in narrative inquiry is to elicit and understand stories, whereas narrative therapy is concerned with fostering a therapeutic relationship. Our hope is that narrative studies do, however, help the audience that consumes our research (whether that is providers, other researchers, politicians, community members) to better understand or appreciate the worldview of the population we are studying.

Fraser (2004) [30] suggests that narrative approaches are particularly well-suited for helping social workers to:

• make sense of language(s) that are used by individuals and groups
• examine multiple perspectives
• better understand human interactions
• develop an appreciation for context
• reduce our role as an expert (we are most called here to be skillful listeners)
• elevate the stories and perspectives of people who may be otherwise be disenfranchised or silenced

Narrative inquiry may be a good fit for your research proposal if you are looking to study some person/groups’ understanding of an event, situation, role, period of time, or occurrence. Again, think about it like a story; what would you form your story plot around. The answer to that gets at the core of your research question for narrative inquiry. You want to understand some aspect of life more clearly through your participant’s eyes. After all, that is what a good story does, transports us into someone else’s world. As a student, you may not be able to access clients directly as research participants, but there are many people around you in your placement, at school, or in the community who may have valuable insights/perspectives on the topic you are interested in studying. In addition, you may be able to access publicly available sources that give you narrative information about a topic: autobiographies, memoirs, oral histories, blogs, journals, editorials, etc. These sources give you indirect information about how the author sees the world —just what you’re looking for! These can become sources of data for you.

What is involved in narrative research?

At the risk of oversimplifying the process of narrative research, it is a journey with stories: finding stories, eliciting stories, hearing and capturing stories, understanding stories, integrating stories, and presenting stories. That being said, each leg of this journey is marked with its own challenges (and rewards!). We won’t be diving deeply into each of these, but we will take time to think through a couple of brief considerations at each of these phases. As you read through these phases, be aware that they reflect the iterative nature of qualitative work that we have discussed previously. This means you won’t necessarily complete one and move on to the next. For instance, you make be in the process of analyzing some of the data you have gathered (phase: understanding stories) and realize that a participant has just blown your mind with a new revelation that you feel like you need to learn more about to adequately complete your research. To do so, you may need to go back to other participants to see if they had similar experiences (phase: eliciting stories) or even go out and do some more recruitment of people who might share in this storyline (phase: finding new stories).

Finding stories

It can feel a bit daunting at first to consider where you would look to find narrative data. We have to determine who possesses the stories we want to hear that will help us to best answer our research question. However, don’t dismay! Stories are all around us. As suggested earlier, as humans, we are constantly evolving stories that help us to make sense of our world, whether we are aware of it or not. Narrative data is not usually just drawn from one source, so this often means thoughtfully seeking out a variety of stories about the topic we are studying. This can include interviews, observations, and a range of other artifacts. As you are thinking about your sample, consult back to Chapter 17 on qualitative sampling to aid you in developing your sampling strategy.

Eliciting stories

So, now you know where you want to get your narrative data, but how will you draw these stories out? As decent and ethical researchers, our objective is to have people share their stories with us, being fully informed about the research process and why we are asking them to share their stories. But this just gets our proverbial foot in the door. Next, we have to get people to talk, to open up and share. Just like in practice settings, this involves the thoughtful use of well-planned open-ended questions. Narrative studies often involve relatively unstructured interviews, where we provide a few broad questions in the hopes of getting people to expound on their perspective. However, we anticipate that we might need to have some strategic probes to help prompt the storytelling process. We also might be looking to extract narrative data from artifacts, in which case the data is there, we just need to locate and make sense of it.

Hearing and capturing storie s

We need to listen! While we are trained in the art of listening as social workers, we need to make sure that we are clear what we are listening for. In narrative research we are listening for important narrative detail. Fraser (2004) [31] identifies that it is important to listen for emotions that the story conveys, the evolution or unfolding of the story, and last but not least, our own reactions. Additionally, we need to consider how we will capture the story—will we record it or will we take field notes ? Again, we may be drawing narrative data from artifacts . If this is the case, we are “listening” with our eyes and through our careful review of materials and detailed note-taking.

Understanding stories

As we are listening, we are attending to many things as we go through this part of the analysis: word choice and meaning, emotions that are expressed/provoked, context of what is being shared, themes or main points, and changes in tone. We want to pay attention to both what the story is and how is it being told.

Integrating stories

Part of the work (and perhaps the most challenging part) of narrative research is the bringing together of many stories. We aim to look across the stories that are shared with us through the data we have gathered and ultimately converge on a narrative that honors both the diversity and the commonality that is reflected therein, all the while tracking our own personal story and the influence it has on shaping the evolving narrative. No small task! While integrating stories, Fraser (2004) [32] also challenges us to consider how these stories coming together are situated within broader socio-political-structural contexts that need to be acknowledged.

• The aim of narrative research is to uncover the stories that humans tell themselves to make sense of the world.
• To turn these stories into research, we need to systematically listen, understand, compare, and eventually combine these into one meta-narrative, providing us with a deeper appreciation of how participants comprehend the issue we are studying.

Know that we have reviewed a number of qualitative designs, reflect on the following questions:

• Which designs suit you well as a social work researcher? What is it about these designs that resonate with you?
• Which designs would really challenge you as a social work researcher? What is it about these designs that make you apprehensive or uneasy?
• What design is best suited for your research question? Is your answer here being swayed by personal preferences?

To learn more about narrative inquiry

Fraser, H. (2004). Doing narrative research: Analysing personal stories line by line.  Qualitative Social Work ,  3 (2), 179-201. https://journals.sagepub.com/doi/abs/10.1177/1473325004043383

Larsson, S., & Sjöblom, Y. (2010). Perspectives on narrative methods in social work research.  International Journal of Social Welfare ,  19 (3), 272-280. https://insights.ovid.com/international-social-welfare/ijsow/2010/07/000/perspectives-narrative-methods-social-work/3/00125820

Riessman, C. K., & Quinney, L. (2005). Narrative in social work: A critical review.  Qualitative Social Work ,  4 (4), 391-412. https://journals.sagepub.com/doi/abs/10.1177/1473325005058643

Rudman, D.L. (2018, August, 24). Narrative inquiry: What’s your story? [Video]. https://www.youtube.com/watch?v=rPyomRrBn_g

Shaw, J. (2017). A renewed call for narrative inquiry as a social work epistemology and methodology. Canadian Social Work Review, 34 (2). https://www.erudit.org/en/journals/cswr/2017-v34-n2-cswr03365/1042889ar/

Writing@CSU, the Writing Studio: Colorado State University. (n.d.). Narrative inquiry. [Webpage]. https://writing.colostate.edu/guides/page.cfm?pageid=1346&guideid=63

For examples of narrative studies

Balogh, A. (2016). A narrative inquiry of charter school social work and the “No Excuses” Behavior Model. Columbia Social Work Review ,  14 (1), 19-25.  https://journals.library.columbia.edu/index.php/cswr/article/view/1855

Klausen, R. K., Blix, B. H., Karlsson, M., Haugsgjerd, S., & Lorem, G. F. (2017). Shared decision making from the service users’ perspective: A narrative study from community mental health centers in northern Norway.  Social Work in Mental Health ,  15 (3), 354-371. https://www.tandfonline.com/doi/abs/10.1080/15332985.2016.1222981

Lietz, C. A., & Strength, M. (2011). Stories of successful reunification: A narrative study of family resilience in child welfare.  Families in Society ,  92 (2), 203-210. https://journals.sagepub.com/doi/abs/10.1606/1044-3894.4102

• Lincoln, Y. S., & Guba, E. G. (2013). The constructivist credo . Walnut Creek, CA: Left Coast Press, Inc. ↵
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Case studies are a type of qualitative research design that focus on a defined case and gathers data to provide a very rich, full understanding of that case. It usually involves gathering data from multiple different sources to get a well-rounded case description.

Findings form a research study that apply to larger group of people (beyond the sample). Producing generalizable findings requires starting with a representative sample.

a paradigm guided by the principles of objectivity, knowability, and deductive logic

a paradigm based on the idea that social context and interaction frame our realities

A thick description is a very complete, detailed, and illustrative of the subject that is being described.

Rigor is the process through which we demonstrate, to the best of our ability, that our research is empirically sound and reflects a scientific approach to knowledge building.

The details/steps outlining how a study will be carried out.

Context is the circumstances surrounding an artifact, event, or experience.

Constructivist research is a qualitative design that seeks to develop a deep understanding of the meaning that people attach to events, experiences, or phenomena.

Research findings are applicable to the group of people who contributed to the knowledge building and the situation in which it took place.

As researchers in the social science, we ourselves are the main tool for conducting our studies.

ensuring that we have correctly captured and reflected an accurate understanding in our findings by clarifying and verifying our findings with our participants

Oral histories are a type of qualitative research design that offers a detailed accounting of a person's life, some event, or experience. This story(ies) is aimed at answering a specific research question.

Ethnography is a qualitative research design that is used when we are attempting to learn about a culture by observing people in their natural environment.

Concept advanced by Albert Bandura that human behavior both shapes and is shaped by their environment.

A qualitative research design that aims to capture and describe the lived experience of some event or "phenomenon" for a group of people.

In a purposive sample, participants are intentionally or hand-selected because of their specific expertise or experience.

also called availability sampling; researcher gathers data from whatever cases happen to be convenient or available

For a snowball sample, a few initial participants are recruited and then we rely on those initial (and successive) participants to help identify additional people to recruit. We thus rely on participants connects and knowledge of the population to aid our recruitment.

An iterative approach means that after planning and once we begin collecting data, we begin analyzing as data as it is coming in.  This early analysis of our (incomplete) data, then impacts our planning, ongoing data gathering and future analysis as it progresses.

Often the end result of a phenomological study, this is a description of the lived experience of the phenomenon being studied.

A research journal that helps the researcher to reflect on and consider their thoughts and reactions to the research process and how it may be shaping the study

A qualitative research technique where the researcher attempts to capture and track their subjective assumptions during the research process. * note, there are other definitions of bracketing, but this is the most widely used.

Those stories that we compose as human beings that allow us to make meaning of our experiences and the world around us

Probes a brief prompts or follow up questions that are used in qualitative interviewing to help draw out additional information on a particular question or idea.

Notes that are taken by the researcher while we are in the field, gathering data.

Artifacts are a source of data for qualitative researcher that exist in some form already, without the research having to create it. They represent a very broad category that can range from print media, to clothing, to tools, to art, to live performances.

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Book description

The authors—noted scholars and researchers—provide an up-to-date guide to qualitative study design, data collection, analysis, and reporting. Step by step, the authors explain a range of methodologies and methods for conducting qualitative research focusing on how they are applied when conducting an actual study. The book includes methods of data collection, specific approaches to qualitative research, and current issues in the field. Specifically, chapters cover the methods, designs, and analyses related to the methodologies of history, case study, program evaluation, ethnography, autoethnography, narrative, life histories, emancipatory discourses, feminist perspectives, African American inquiry, indigenous studies, and practitioner qualitative research.

Table of contents

• To the Instructor
• To the Student
• Acknowledgments
• A Tour of This Text
• THE EDITORS
• THE CONTRIBUTORS
• Disciplined Inquiry
• Historical Roots of Qualitative Research
• A Word About Method and Methodology
• Overview of the Text
• Preview of the Chapters
• Further Readings and Resources
• Ethical Dilemmas in Research
• Guidance for the Ethical Conduct of Research
• Ethical Principles
• Ethical Norms for Research
• Doing Grounded Theory Research
• Memo Writing
• Theoretical Sampling and Saturation
• Theoretical Sensitivity and Using the Literature

Research Methodology

• Making Methodological Decisions
• Research Methods
• Selecting Methods or Tools
• Data Analysis
• Historical and Theoretical Background
• Contemporary Biography and Life Story Research Design
• Data Collection Instruments and Analytic Approaches
• The Meaning of Reliability and Validity
• Dissemination of Findings
• The What: What We Are Trying to Understand
• The When: The Historical Context of an Earlier Era
• The Where: The Foci of Historical Studies
• The Who: Historical Actors
• The How: The Evidence Behind Historical Research
• The Why: Historical Interpretation and Analysis
• What Is Ethnographic Research?
• How Does an Ethnographer Start?
• What Do Ethnographers Do?
• What Do Ethnographers Do with Their Data?
• What Does Ethnographic Writing Look Like?
• How Do We Know an Ethnography Is Good?
• What's the State of Ethnography Today?
• Walking a Fine Line: Tony's Introduction
• Hiking into “Two Men's” Land: Carolyn's Introduction
• Teaching By Fire: Together, Talking About Autoethnography
• Doing Autoethnography: Continuing the Conversation
• Writing Autoethnography
• Autoethnographic Forms
• Benefits of Autoethnography
• Critical Responses to Autoethnography
• Talking the Talk and Walking the Walk
• Narrative Inquiry: Introduction
• Narrative Inquiry: Critical Event Approach
• Narrative Inquiry: Qualitative Research Methodology
• Narrative Inquiry: Genres
• Narrative Inquiry: Responses to Critique
• Narrative Inquiry: How to Begin
• Characteristics of a Case Study
• Planning Case Study Research
• Implementing Case Study Research
• Case Study Reports
• Background of Arts-Based Research
• Purposes of Arts-Based Research Studies
• Planning and Conducting Arts-Based Research Studies
• Example Studies
• Learning from Arts-Based Studies
• Trusting Arts-Based Studies
• Historical Perspective
• Research and Professional Practice
• Practitioner Research in Action: Two Scenarios
• Characteristics of Practitioner Research
• Practitioner Research Designs
• Engaging in Practitioner Research
• Trusting Practitioner Research Results
• What Is Evaluation?
• Evaluation Approaches
• Guiding Principles for Evaluators
• Evaluation Design
• Believing Evaluation Findings
• Evaluation Use
• Culture and Race
• Culturally Responsive Evaluation
• Logic Models
• African American Culturally Responsive Evaluation System for Academic Settings
• Beginning to Understand Critical Ethnography
• Theoretical and Historical Foundations of Critical Ethnography
• Defining Elements of Critical Ethnography
• Doing Critical Ethnography
• Critiques of Critical Ethnography
• Historical Roots of Feminist Research
• Guiding Principles of Feminist Research
• Feminist Approaches
• Trusting Feminist Reports
• Colonization and the Call for (Re)Claiming an Indigenous Intellectual Life and Thought-World
• Epistemological, Ontological, and Axiological Considerations in Research
• What Is a Critical Indigenous Research Methodologies Framework?
• What Makes the “Critical” Critical?
• Where Do We Go from Here? Moving Forward and the Reclamation of Voice
• The Denver Study
• Deliberative Democratic Research

Product information

• Title: Qualitative Research: An Introduction to Methods and Designs
• Release date: December 2011
• Publisher(s): Jossey-Bass
• ISBN: 9780470548004

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An Introduction to Qualitative Research

• Uwe Flick - Freie Universtität Berlin, Germany
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Continuing to be THE guide to the whole qualitative research process for students, this book looks at both the theory behind qualitative research and how to put it into practice in your own work. For students across a range of social science disciplines and beyond, this is a must to help you enhance your research project. This edition introduces:   

• a decolonisation of methodologies   
• a range of indigenous, queer and feminist perspectives on methodologies
• assistance with defending a viva and alternative forms of assessment to suit a changing world.

More additions to this seventh edition include a section on the subjectivity of a researcher, and how your identity will shape your research. The further reading has been curated to include more than just western voices, providing you with global perspectives on qualitative research. This text introduces how to sensitively undertake ethical and inclusive research with marginalised groups. This book will help you master a comprehensive understanding of qualitative research.

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Professor Uwe Flick has been a leading qualitative methodologist in the social sciences for decades. His methods texts reflect his considerable talent for presenting complex concepts and approaches in a thorough and accessible manner. This latest text is no exception.

An Introduction to Qualitative Research is a comprehensive guide to the qualitative research process written by an accomplished expert in the field. Uwe Flick is relentless in his efforts and ambition to spread knowledge about a rich research tradition that is continually evolving and refined within the social sciences. It is a volume with both breadth and depth containing what you need to know about qualitative research to be able to try it out. Also more experienced qualitative researchers will find this text valuable and insightful. By covering different research traditions and the use of many examples from real research, the author points out a variety of vital themes for qualitative research and captures its richness.

In the 7th edition of his well-proven Introduction to Qualitative Research the marked expert on qualitative Research, Prof. Flick, has upgraded the scope of his thoroughly basic textbook (e.g.: actual debates on post-colonial perspectives, mixed-methods, qualitative online research). A special merit of the Introduction is, that students get a feeling of what qualitative research is about: many well conditioned didactically examples of classic studies as well as of Flicks and his students´ own research encourage students to do their first steps in Qualitative Research. 

A gentle, supportive, engaging guidebook to the complex terrain of qualitative research. I recommend this book to students because it introduces key debates without jargon, and provides a practical scaffolding for one’s own research design by synthesising each chapter’s learning in a series of critical questions. 

Really useful reference book for students using qualitative research. The addition of non-Western perspectives is particularly helpful.

This is an excellent source for our students. We have recently used a different book for our module, however, this is a valuable resource to help students who are completing qualitative research for their dissertations.

This is a great book for both beginners and seasoned qualitative researchers

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Great overview of different research methods that will be really helpful for my students

A very clear introduction to QR - easy to navigate and find information quickly for busy students. Real world application and question prompts mean students can use the book in an active way.

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Qualitative Inquiry and Research Design Choosing Among Five Approaches

• John W. Creswell - Department of Family Medicine, University of Michigan
• Cheryl N. Poth - University of Alberta, Canada
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“The Fourth Edition of Qualitative Inquiry and Research Design is refreshingly readable and will be accessible to students of all levels. This is a great text on the subject. Kudos to the authors!"

“In my teaching experience, I have found this to be the best text for teaching an introductory course in qualitative research, as it demonstrates in a clear and systematic manner how qualitative research can be undertaken in the five most popular approaches in contemporary applied social science research.”

“I have been using Creswell’s text since I studied the first edition as a student myself, and every edition has been a notable improvement on what was already an excellent book. I have yet to see another book that packs in as much vital information with such clarity and friendly writing.”

“Creswell and Poth’s newly revised edition of Qualitative Inquiry and Research Design represents an accessible yet in-depth resource for developing an understanding of both the main approaches to qualitative research in the social sciences, as well as the wide variation across and beyond these approaches.”

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• Strengthened focus on inclusivity and diversity is reflected in examples and references throughout the book.
• Additional visual depictions of the five approaches assist visual learners and enhance student understanding.
• Two new studies in Chapter 5 provide new insights on case study and ethnographic research.
• Greater integration of issues of data management and articles reflective of developments in data collection introduces new ways of gathering qualitative data.
• Expanded end-of-chapter exercises give readers more opportunities to test their understanding and apply concepts.
• A wide range of coverage includes comparison of theoretical frameworks, ways to employ standards of quality, and strategies for writing introductions, collecting data, analyzing data, writing a narrative, and verifying results.
• An emphasis on social justice as one of the primary features of qualitative research can be seen throughout the book.
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How to Write an Introduction for a Qualitative Research Study

How to Write a Lab Report Conclusion

There are two different accepted methods of conducting research in social sciences. These are quantitative and qualitative research studies. Both methods can be used to test hypotheses by carrying out investigations with groups of participants, but they achieve that in different ways. Quantitative research relies solely on numbers. For instance, the researcher may give out surveys to a large number of participants and then analyze the data from their answers by looking for patterns and correlations among different variables. In these studies, numerical data are analyzed using various statistical methods, and the researcher may not have to ever talk to any participants face-to-face.

When conducting qualitative research, the researcher often relies on a smaller group of participants, often conducts individual interviews with them and is interested in hearing their perspectives. The goal of a qualitative study isn't to find wide generalizations but to identify and analyze specific examples of a certain phenomenon and consider its possible implications. Qualitative methods often include in-depth interviews, group discussions and general participant observations by the researcher.

Why an Introduction is Important

An introduction is a crucial part of your study because it gives your readers a road map of what they can expect in reading your paper. It doesn't need to be long or elaborate, but it has to include the following elements.

State the Problem

Introduce the reader to the issue that your study addresses. Provide a concise overview of the problem and mention briefly how previous studies (if any) attempted to solve it. Don't go into details here. You'll have a chance to write a more in-depth literature review later.

Describe the Methods

Give the reader a brief overview (a couple of sentences will suffice) of the methodology you employed in your study. This is where you make it clear that your study relies on qualitative research methods. Again, don't go into as much detail as you will later in the methodology section.

State the Conclusion

That’s right. State the conclusion right in the introduction. It can be tempting to keep this part a secret until the reader gets to the end (why give everything away, you may be thinking?), but remember, you’re not writing a work of fiction. Your reader doesn't want to be surprised. They want an overview of what to expect in the conclusion and how you got there.

Address the Bigger Picture

Explain why this study is important in the bigger scheme of things. Think beyond the particular problem that your study addresses. What bigger questions will it help solve?

Related Articles

How to Write a Study Report

How to Write the Objectives for Study Proposals

How to Write a Microbiology Research Proposal

How to Write a Close Reading Essay

How to Write a Research Plan for a Science Project

How to Write a Technical Essay

How to Write an Investigation Essay

How to Create a Literature Review Outline

• University of Southern California Libraries: Organizing Your Social Sciences Research Paper: 4. The Introduction
• Though quantitative methods are often employed as an effort of supporting the results and interpretations in a qualitative research study, they are not and should not be the focus of the report. Consequently, in your explanation and justification sections of your introduction, indicate the ways in which quantitative research played a complementary role to your qualitative analysis.

Tanya Mozias Slavin is a former academic and language teacher. She writes about education and linguistic technology, and has published articles in the Washington Post, Fast Company, CBC and other places. Find her at www.tanyamoziasslavin.com

• Open access
• Published: 12 April 2024

Healthcare team resilience during COVID-19: a qualitative study

• John W. Ambrose 1 ,
• Ken Catchpole 2 ,
• Heather L. Evans 3 ,
• Lynne S. Nemeth 1 ,
• Diana M. Layne 1 &
• Michelle Nichols 1  

BMC Health Services Research volume  24 , Article number:  459 ( 2024 ) Cite this article

176 Accesses

Metrics details

Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization.

We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework.

Five themes were identified from the interviews with acute care professionals across the US ( N  = 22): teamwork in a pressure cooker , consistent with working in a high stress environment; healthcare team cohesion , applying past lessons to present challenges , congruent with transferring past skills to current situations; knowledge gaps , and altruistic behaviors , aligned with sense of duty and personal responsibility to the team. Participants’ described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance.

Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.

Peer Review reports

Introduction

The COVID-19 pandemic highlighted the complexity and dynamic nature of healthcare systems. It also created a unique opportunity to look at the concept of resilience through the lens of the healthcare team versus the more common approach of situating the concept within the individual or the organization. The early phase of the pandemic was marked by challenges, such as limited access to personal protective equipment, personnel shortages, drug shortages, and increased risks of infection [ 1 , 2 ]. Ensuring patient safety and proper functioning requires coordination and adaptation of the healthcare team and various processes across the health system infrastructure [ 3 , 4 ]. Resilience results from adaptive coordination which enables healthcare systems to maintain routine function in the face of all conditions [ 5 , 6 ].

Resilience in healthcare has been operationalized through resilience engineering, an interdisciplinary aspect of systems engineering focused on promotingpatient safety through the design, implementation, and management of healthcare systems [ 7 , 8 , 9 ] (e.g., how healthcare systems adapt and adjust to maneuver through the daily complexities and challenges to identify effective practices, prevent errors and maintain resilient performance) [ 6 , 8 , 9 , 10 , 11 ]. Resilient performance in healthcare is proposed to be the net result of reaching the threshold of four resilience capabilities within the system: anticipation, the ability to expect and prepare for the unexpected; monitoring, the ability to observe threats to daily system performance; responding, the ability to adapt how the performance is enacted; and learning, the ability to learn from present and past accomplishments within the system [ 12 ]. At present, there is a paucity of research on the resilience of the healthcare team as a cohesive, singular conscious source of knowledge in a highly complex healthcare system. While the resilience of both healthcare systems [ 11 , 13 ] and healthcare workers [ 14 ] has been investigated, there is a gap in knowledge specific to the resilience of the healthcare team as a unified singular consciousness. The circumstances surrounding the COVID-19 pandemic presented a unique opportunity to understand the resilience of the healthcare team in a highly complex system as a singular aware entity within the system; how it acknowledges itself, defines its purpose, and performs under extenuating circumstances. This shifts the emphasis of individual and organization resilience to the resilience in the interconnected healthcare team that extends beyond the boundary of any single person.

The adapted model situates the healthcare team as a cohesive singlular conscious source of knowledge within an intricate and highly complex system [ 15 ]. This model was designed as a bridge between resilience found in individuals within the healthcare system and the organization to emphasize the healthcare team as an aware, unified whole. Our model [ 15 ] combines the existing Systems Engineering Initiative for Patient Safety (SEIPS) model [ 16 ] (version 1), which is based on five domains (organization, person, tasks, technologies, and tools), and environment and the Advanced Team Decision Making Model [ 17 ], which includes components for team performance [ 17 , 18 , 19 ]. Team performance is comprised of team identity, team cognition, team competency, and team metacognition [ 17 , 18 , 19 ]. Team identity describes how the team identifies their purpose to help one another [ 17 ]. Team cognition describes the state of mind of the team, their focus, and common goals [ 17 ]. Team competency describes how well the team accomplishes tasks, and team metacognition describes problem solving and responsibility [ 17 , 19 ], Fig.  1 .

Healthcare Team as a cohesive, singular conscious source of knowledge in a highly complex system. The continuous variegated border represents the singularity and connectedness of the healthcare team within the system. The gears represent the processes, people, technology, and tasks within this highly dynamic healthcare system

The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a singular conscious source of knowledge defined by its collective identity, purpose, competence, and actions. Additionally, we sought to identify factors that may facilitate or hinder the healthcare team from achieving the necessary capabilities to monitor, anticipate, adapt, and learn to meet the standard for resilient performance.

Methodology

A qualitative descriptive design [ 20 , 21 ] was employed. The interview guide was framed using the adapted model to explore various aspects of healthcare team performance (identity, purpose, competence, and cognition). These questions were pilot tested on the first 3 participants and no further changes were needed. Specifically, we aimed to investigate resilience capabilities, decision-making processes, and overall healthcare team performance.

Sampling strategy

A purposive snowball sample was used to identify healthcare team members who worked in U.S. acute care settings between January 2020–December 2020. This sampling method was used to ensure recruitment of participants most likely to have insight into the phenomenon of resilience in the acute care setting.

Inclusion criteria

To explore a wide range of interprofessional experience, participants were recruited across geographic regions and professional roles through personal contacts and social media [ 22 , 23 , 24 , 25 ]. Eligible participants included English-speaking individuals ages 20 and older with a valid personal email address, internet access, and the ability to participate in an online video interview. Potential participants had to be employed full or part-time for any period from January 2020–December 2020 in any of the following acute healthcare environments: emergency room (ER), intensive care unit (ICU), COVID- 19 ICU, COVID-19 floor, gastroenterology inpatient unit, endoscopy suite, operating room (OR), post anesthesia recovery room (PACU), pre-operative holding area, hospital administration, or inpatient medical and/or surgical patient care unit.

Exclusion criteria

Healthcare team members who did not complete the pre-screening survey or failed to schedule an interview were not enrolled.

National recruitment in the U.S

Upon approval by MUSC Institutional Review Board (IRB), registered under Pro00100917, fliers, social media posts on Twitter TM (version 9.34 IOS, San Francisco, California) and Facebook TM (version 390.1 IOS, Menlo Park, CA), and word of mouth were used to initiate recruitment efforts. Interested participants were sent a link to an electronic screening survey explaining the purpose of the study and verifying the respondents’ eligibility to participate. Informed consent was obtained from all subjects.

Data collection

Data were collected via an initial screening questionnaire to determine eligibility. Data were managed using REDCap™ (version 11.2.2) electronic data capture tools hosted at MUSC. Demographic data included age, sex, race, professional role, years of experience, geographic region, patient population served, practice specialty area, and deployment status during the pandemic. Deployment refers to the reassignment of personnel from their primary clinical area to another area to meet the demands of another clinical area without regard for the participant’s clinical expertise. Qualitative data were collected through semi-structured audio video recorded interviews to understand the healthcare team in their natural environment. Recorded interviews were conducted via Microsoft® Teams (version 1.5.00.17261, Microsoft Corporation) from the PIs private office to mitigate the risk of COVID-19 transmission and promote participation across the U.S.

Data monitoring and safety

The quality of the demographic data was monitored to ensure completeness. Potential participants who submitted incomplete responses on the questionnaire were excluded. Interviews were transcribed using software, transcriptions were reviewed and verified for accuracy, and then uploaded to MAXQDA Analytics Pro, Version 2022 (VERBI software) to facilitate data analysis. Transcripts were not returned to the participants. Qualitative codebooks, institutional review board (IRB) logs, and other study records were stored on a secure university server, with access limited to authorized study personnel. Adherence to Consolidated Criteria for Reporting Qualitative Research (COREQ) standards were maintained throughout the study and analysis [ 26 ].

Data analysis

Quantitative analysis.

Demographic data were analyzed using SPSS Statistics for MAC, version 28 (IBM). Both descriptive statistics for the continuous variables of age and years of experience (mean, standard deviation) and frequency tables (age, sex, race, role, geographic region, population served, deployment status) were analyzed.

Qualitative analysis

The Principal Investigator (PI) (JA) and senior mentor (MN) independently coded the interview transcripts. Open coding method was used to identify the categories of data [ 22 , 27 ]. Both a reflexive journal and audit trail were maintained. Codes were identified through induction from participant experiences and verified through weekly consensus meetings, while theoretical deductive analysis was guided by the adapted model and the four resilience capabilities (anticipation, monitoring, responding, learning [ 12 ]. Reflexive thematic analysis (TA) [ 28 , 29 , 30 , 31 ] was used to analyze the coded data and generate themes. Data were collected and categorized into the codebook until no further codes were identified by the PI and research mentor [ 22 , 27 ]. Participant checking was not employed.

Demographics

The eligibility pool was established based on survey completion. Eighty-nine healthcare team members opened the online screening survey; 21 were incomplete and eliminated from the dataset, which left a pool of 68 potential eligible participants. Eligible participants (100%) were contacted by email and phone to determine their interest in completing the study interview. Twenty-two participants completed screening surveys and study interviews between May–September 2021, equating to a 32.5% enrollment rate. Participant interviews lasted between 21 and 91 min with an average of 43 min. None of the interviews were repeated. Participant demographics, including descriptive statistic and role key, are noted in Tables  1 and 2 , respectively.

Five themes were identified: team work in a pressure cooker , healthcare team cohesion , applying past lessons to present challenges , knowledge gaps , and altruistic behaviors .

Teamwork in a pressure cooker

The theme teamwork in a pressure cooker describes the relentless pressures and emotional stressors (e.g., fear, anxiety, frustration, and stress) experienced by the healthcare team from the risks and potential threats associated with COVID-19 contamination and infection. Factors associated with these pressures included risk of COVID-19 exposure, lack of COVID-19 testing, rapid changes to policies and procedures from the standard, personnel shortages, limited physical space, and limited supplies. Exemplary quotes highlighting participant descriptions of these pressures or subthemes are noted in Table  3 .

The healthcare team described an unprecedented level of stress in the workplace as the healthcare team had to adjust to rapidly changing protocols. The lack of protective equipment, shortage of providers to perform patient care and a lack of a familiar clinical routine saturated them in overwhelming pressure and emotions that stuck to them as they navigated uncharted territory. Exemplary quotes highlighting the healthcare team’s descriptions of these emotions are noted in Table  4 .

“It was…uncharted territory for me.” (P1, DIR) “You were stuck in a situation you never— you didn’t know when it was going to end.” (P4, RN PACU) “They have not enough staff—they can’t do it—they—I don’t know what we’re going to do.” (P6, DIR). “When we deployed—trying to get re-accustomed to the changes—with the needs that had to be met was very difficult.” (P10, RN ENDO) “I wasn’t about to sign up for extra time working in under those stressful conditions.” (P17, RN PACU)

The fear of the unknown, combined with the constant need to adapt to rapidly changing circumstances, led to widespread stress, frustration, anxiety, and exhaustion within the healthcare team. This theme was characterized by the constant pressure both inside and outside of work experienced by the healthcare team.

“Driving to the hospital, crying, driving back from the hospital, crying, still doesn’t sum it up— surrounded by people who were just dying. And what could you do?” (P6, DIR) “It was constant. It was terrible. I couldn’t sleep at night. I’d wake up worried.” (P8, ER MD) “It was kind of like just keep sending the Calvary forward—and when one drops, you just walk over them.” (P17, RN PACU) “It was always there—COVID here, COVID there—you never could just completely get away from it. It was basically the center of everybody’s conversation everywhere you went or if you were on the phone with somebody.” (P18, RN COVID ICU) “I was having to call my parents before I’d leave my apartment to go into work— to vent to them and cry— to let out my frustration and my anxiety—and have them essentially convince me to go into work.” (P19, RN ICU). “Working so much— COVID was all that was on my brain—and it was a lot of pressure.” (P22, MGR)

Working during COVID-19 challenged the resilience of the healthcare team in the face of constant fear and uncertainty. The pressure to maintain team performance, while dealing with constant fear associated with the pandemic effected the healthcare team’s resilience.

“I have to tell you that after being in hospital—I don’t feel resilient right now— doing all the things I’ve done—I just want to be out of the hospital— [crying] I can tell you that it will stay with me the rest of my life— It will always stay with me.” (P6, DIR) “I feel like my team has used up all of their resilience. I don’t think there’s much left.” (P8, ER MD)

However, one team member stood out as an exception. They reported the pressures from the environment helped them to make decisions. This demonstrates that environmental pressures affect members of the healthcare team differently. They reported that the pressure and intensity of the situation sharpened their focus and allowed them to make choices more quickly and effectively.

“I make better decisions when I’m under pressure.” (P22, MGR)

Healthcare team cohesion

The theme healthcare team cohesion describes the unique experience of working together during the pandemic that created a means among the healthcare team to form close relationships and unite. This bond was characterized by the emergence of strong interpersonal connections among healthcare professionals during the COVID-19 pandemic. These connections shaped healthcare team relationships and were a factor in the collaborative decision-making processes within healthcare team for their day-to day functions. This cohesive bonding was fueled by the stress and uncertainty of the situation, which brought the healthcare team together illustrated by their solidarity, camaraderie, trust, and empowerment.

“All those decisions, important decisions were made together.” (P7, CRNA) “Everyone felt like they were they were, you know, in a in a battle zone and on the same side—and so that kind of brought people together.” (P8, ER MD) “I think our team worked as one.” (P11, CEO)

Solidarity described the sense of unity evident among the members of the healthcare team. This was characterized by connectedness and a sense of reliance on one another that promoted teamwork and resilience within the team from support both given and received. The sub-theme camaraderie described the close personal connection and support between the healthcare team that went beyond normal social interactions prior to the pandemic. These connections were filled with trust and respect for other healthcare team members.

“I think we were all trying to do the best we could do and help each other do the best they could do—I think early on just camaraderie helped a lot within the department and, you know, just relying on each other for support.” (P8, ER MD) “We knew that we can depend on each other and we all had different skill sets— I think that that was very important—that made us feel secure— rather than going alone.” (P10, RN ENDO) “We [The ICU Nurses] developed a sense of camaraderie that I mean, it’s nothing I’ve ever felt before, like we had to trust each other with our licenses, with our own health—my resiliency came from my coworkers.” (P14, CHG RN) “One of the things that I think the pandemic did in a positive—was—I believe that the teams that I worked for really started to solidify. We leaned on each other. I felt more of a team environment than I had had pre-pandemic—I felt that people were a bit better together. We all needed each other, and we all leaned on each other, and we gave each other support—more so than before COVID- 19.” (P15, CRNA) ”The nurses on the unit were always there for me—they became my friends— my family.” (P19, RN ICU)

The sub theme of empowerment referred to the ability of the healthcare team to confidently make decisions and assume responsibility for their actions within the healthcare setting. This process involved a sense of authority and the ability to exercise agency in decision-making together to respond and adapt to the demands the healthcare team experienced. The combination of solidarity, camaraderie, trust, and empowerment resulted in a strong sense of cohesion within the healthcare team which led to improved relationships and enhanced resilience in their performance.

“I felt that I felt that the team—we all needed each other and we all leaned on each other and we gave each other support—more so than before COVID.” (P15, CRNA) “How do you want to handle this? What’s the plan?—and we collaborated in the true sense of collaboration.” (P15, CRNA) “We just knew that we could count on each other—we knew that we could count on each other at any time if we had questions, because we all worked so closely together during this. We really became a really tight knit group, and it was great.” (P22, MGR)

The benefits of the cohesion found in the healthcare team were significant and apparent during the COVID-19 pandemic. The strengthened relationships and increased resilience allowed for improved communication and collaboration, leading to better patient care and outcomes. Despite these advantages, it was noted by one participant that the relationships developed were not sustained beyond the peak of the pandemic.

“Now that COVID is kind of at bay in our area, it’s kind of gone back to the same way it was— it has not stuck.” (P15, CRNA)

Applying past lessons to present challenges

The theme applying past lessons to present challenges describes how the knowledge and understanding gained from prior participant experiences was used to adapt to the novel clinical and infrastructural challenges faced during the pandemic. Past experiences facilitated the healthcare team to strategize ways to meet the demands of the healthcare system during this time.

Participants described two strategies the healthcare team used to improve the system’s ability to adapt and function effectively: changing roles and deploying personnel. The process of changing roles involved assigning new responsibilities to individuals based on priority-based initiatives, while deployment involved transferring clinical staff from areas with lower patient care needs to those with higher needs to optimize their utilization. Eleven participants (50%) were affected by these strategies. Of these, 73% were assigned to clinical areas for direct patient care, while the remaining 27% underwent a role change to support the operational needs of the system. The participants’ preexisting work relationships, specialized clinical expertise, and leadership abilities helped them adapt to their new clinical and non-clinical roles, which in turn enhanced the resilience of the healthcare team.

“We wanted to make sure that we were putting people into the right area where their skill set could be used the best.” (P1, DIR) “I’m known for moving people forward—I’m also well known for speaking up when I don’t think it is right and there was a lot of stuff that I didn’t think was right— and not only speaking up, I’m also going to come with the solution.” (P6, DIR)

Participants indicated the lessons learned from prior experience positively impacted team performance and improved patient care outcomes. There were two significant examples in the data: the perspective of a nurse who was redeployed to work in an obstetrics unit (P5, ENDO RN) and the perspective of a nursing director (P6, DIR) whose role was changed to develop a program to ensure adequate staffing.

“Because we [the team of interprofessionals] were all very familiar with what we had to do at the task, at handit [the experience of the provision of care] was very fluid—I think it’s because of our years of experience and working with each other for so long that it just worked out very well ”. (P5, ENDO RN) “Staff believed in me when I said I would do something— I could galvanize people because of my reputation of caring for staff, so I was chosen specifically because of my ability to move people forward in spite of things.” (P6, DIR)

Participants identified being assigned to unfamiliar clinical areas or working with unfamiliar patient populations as a barrier that hindered their ability to adapt to clinical situations. The lack of clinical competence among some personnel led to an increase in workload for other healthcare team members, who had to provide additional instruction and guidance on how to complete the task. Decision-makers who deployed nursing staff to a clinical area with higher staffing needs may have believed that the individual nurse had specific clinical skills that would be helpful in that area, and this was not the case.

“She [the patient] felt like it was that he [the new nurse]—really didn’t know what he was doing—not only were we kind of reintroduced to that role of caring for patients where we haven’t been recently, but we’re also in a teaching mode, too, for the new nurses—we had to prioritize how sick the patients were, from basic vital signs to wound dressings to respiratory, and help those new nurses know which to attend to first.” (P10, RN ENDO) “Nurses weren’t really put in a place with enough support and enough resources to be able to do a job, and to do a job that maybe they haven’t done for a few years.” (P10, RN ENDO)

The participants indicated that clinical competencies of a healthcare provider in one patient population may not necessarily be applicable to another patient group. For instance, a neonatal intensive care unit (NICU) nurse who has experience in managing Extra Corporeal Membranous Oxygen (ECMO) in newborns may not have the necessary skills to care for adult ECMO patients in an adult COVID-19 intensive care unit.

“The ECMO nurse was a NICU nurse, so she really could not help me.” (P14, CHG RN)

Knowledge gaps

The theme knowledge gaps refers to the disparity between the existing knowledge of the healthcare team and the knowledge required for the team to effectively respond and adapt to the needs of the healthcare system. The lack of COVID-19 specific knowledge led to gaps in the healthcare team’s understanding, while the lack of communication made it difficult for necessary information to be effectively conveyed and received (e.g., medical logistics, human resources, and other operational policies and procedures). This knowledge gap created a barrier to healthcare team resilience as their capacities to surveil, anticipate, and respond were diminished from the lack of knowledge.

“That [information] is pretty fundamental to how you [the healthcare team] function.” (P17, RN PACU) “I don’t think any amount of preparation could have actually prepared us for how bad COVID was—but we were very, very, very unprepared.” (P18, RN COVID ICU) “It was confusing, it was disruptive to the patients that we had there. They sensed that. And that’s— OK—screw with me, screw with my colleagues, but don’t screw with the patient.” (P21, RN ENDO)

All the participants in leadership roles during the COVID-19 pandemic emphasized the importance of having a thorough understanding of the information and effectively communicating it to the frontline healthcare team members most involved in providing patient care.

“There’s nothing worse than having to learn something in the moment and not being prepared for it.” (P1, DIR) “That made us communicate in multiple ways throughout a day because we all know people learn and adapt it could be in print. It could be in person; it could be a video. We tried to have multiple ways of getting messages out and knowing we needed to repeat messages because this was so unknown, and people were so stressed.” (P11, CEO)

One team member (P13, CRNA), highlighted areas where there were gaps in knowledge in greater detail.

“It was as if the unit was being run by all these sort of substitute teachers that were called in at the last minute. Nobody knew where stuff was—nobody knew what the protocol was—the communication was terrible.” (P13, CRNA)

The cumulative effect from the knowledge gaps contributed to the lack of a practical working knowledge for the healthcare team and affected the healthcare team’s ability to anticipate what needed to be done and adapt their performance to accomplish it. Despite knowledge gaps, healthcare team members reported their capability to learn was facilitated by incremental gains in practical knowledge through their experience over time.

“—people got to be experts at protecting patients and keeping themselves safe.” (P8, ER MD) “I think it kind of was like on the job training at that point, I felt like we were all just trying to survive—learning was like—you went out —then you came back, and you would share how things went.” (P15, CRNA) “You tried to educate yourself so you could be safe.” (P17, RN PACU)

The participant responses received from the leadership (CNO, Directors, and Manager) and front-line personnel (administrative staff, nurses, and physicians) regarding the importance of communication highlighted a difference in perspective. Leadership exhibited a strong commitment toward effective communication and made efforts to ensure all healthcare team members were well informed. On the other hand, the frontline participants indicated instances where communication strategies were not perceived as effective.

“I wasn’t contacted by a manager from the unit or anything to be able to reassure, reassure me that things were being followed through and it should be okay, so that was tough.” (P10, RN ENDO) “It really seemed like there was no communication between—like staffing and the floor—we would get up to the floor and they would say, who are you? What are you doing here? What are we supposed to do with you?” (P20, RN OR)

Altruistic behaviors

The theme altruistic behaviors , encompasses the participants’ perception of their obligation and accountability to their patients and healthcare team, and their steadfastness in supporting the healthcare team even if it meant facing personal or professional repercussions. This readiness to aid the healthcare team and accept consequences showcased their altruism and commitment to the healthcare team. The team’s dedication to both their patients and each other was a primary focus driven by a strong sense of responsibility and obligation.

“I want to be able to look myself in the mirror and feel like I did the right thing—.” (P6, DIR) “My resiliency came from my coworkers. I wanted to come back to work to help them.” (P14, RN COVID ICU) “People really looked out for each other—and people were really kind and compassionate to each other—we all were in this together.” (P15, CRNA) “I’m grateful for the experience that I had and all of the different patients that I was able to help in my time there definitely solidified that being a nurse is what I needed to do—and why I chose the profession is exactly what I should have been doing.” (P19, RN ICU) “You just have to go with what seems right—.” (P22, MGR)

A defining characteristic of this theme was a willingness to endure consequences for the benefit of the healthcare team. These consequences varied from contracting the virus, facing criticism from the healthcare team, to foregoing financial incentives, and even job loss.

“I felt like I was punished for speaking up and I was punished for doing the right thing for patients.” (P6, DIR) “I mean, I literally broke the law so many times. Do you know how many times I started pressors [vasoactive drugs to increase blood pressure] on patients that I had no orders for [because a physician would not enter the ICU]?” (P14, CHG RN)

We identified five key themes based on the coded data; namely teamwork in a pressure cooker , healthcare team cohesion , applying past lessons to present challenges , knowledge gaps , and altruistic behaviors . The researchers propose that stressors arising from the COVID-19 pandemic had an impact on the healthcare team’s resilience. In addition, strong healthcare team cohesion, selfless behaviors among the healthcare team, shared knowledge, and job competence within the healthcare team, enhanced resilient performance.

The healthcare team experienced significant stress and uncertainty, due to the COVID-19 pandemic. This is consistent with previous research that has shown that the unprecedented nature of the pandemic led to challenging working conditions, limited resources, lack of information, and concerns about infecting loved ones [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The collective global impact of COVID-19 on healthcare systems is likely a contributing factor to these stressors [ 45 , 46 , 47 , 48 ].

Our study, along with those conducted by Anjara et al. (2021)[ 49 ] and Kaye-Kauderer et al. (2022) [ 50 ], found that solidarity and camaraderie among healthcare professionals improve resilience. Specifically, Anjara et al. observed increased collaboration among the healthcare professionals they studied in Ireland during the COVID-19 pandemic, while Kaye-Kauderer et al. identified team camaraderie among their sample of front-line healthcare workers from New York. Kinsella et al. (2023) [ 51 ] reported that COVID − 19 offered frontline workers in the UK the opportunity to work together toward a common goal. Potential explanations for these findings align with the concepts of social capital proposed by Coleman [ 52 ] and social identification with other as proposed by Drury [ 54 ]. Coleman suggests an individual’s skills and capabilities are enhanced through their interdependent relationships with others [ 52 ]. Drury found in communities affected by disasters, mutual aid and support emerged from a shared social identity, which serves to strengthen the community [ 53 ]. Brooks et al. (2021) [ 54 ] conducted a study with healthcare, police, and commercial sectors in England. They found it was important for these individuals to receive support from and provide support to their colleagues to mitigate the psychological impact of disaster exposure [ 54 ]. In addition, like our findings, Aufegger and colleague’s 2019 systematic review [ 55 ] found that social support in acute care healthcare teams creates a supportive atmosphere where team members help each other communicate problems, fulfill needs, and deal with stress.

Our results are consistent with those of Liu et al. (2020) [ 32 ] and Banerjee et al. (2021) [ 44 ] who each found that healthcare professionals frequently feel a sense of personal responsibility to overcome challenges. One potential explanation for this may be the influence of collectivism in their cultures. Similarly, our study suggests the sense of camaraderie among healthcare professionals may also contribute to a sense of responsibility and increased altruistic behavior. However, other studies have highlighted different perspectives on healthcare professionals’ sense of responsibility and duty. Godkin and Markwell’s (2003) [ 56 ] revealed that healthcare professionals’ sense of responsibility during the Severe Acute Respiratory Syndrome (SARS) outbreak was dependent on the protective measures and support offered by the healthcare system where most SARS infected patients were hospitalized. More recently, Gray et al. (2021) reported that nurses’ sense of responsibility stems from their ethical obligations, regardless of potential personal or familial risks [ 57 ].

The altruistic behaviors described by our participants helped maintain the performance of the healthcare team. It is too soon to see the long-term impact from working in this high-pressure environment; however, past research by Liu et al. (2012) [ 58 ] and Wu (2009) [ 59 ] demonstrated that “altruistic-risk acceptance” during the SARS outbreak was shown to decrease depressive symptoms among hospital employees in China.

Our research on resilience has important implications for healthcare organizations and professionals. In order to ready themselves for forthcoming events, healthcare systems must emphasize the significance of shared knowledge and its influence on the healthcare team’s ability to foresee and monitor effectively. This knowledge can help the healthcare organization function as a unified entity, rather than as individuals in separate roles or clusters within the organization to improve healthcare team preparedness. Establishing a cohesive, clinically competent healthcare team benefits the organization and the patients served. Measures to enhance social support, improve communication and ensure clinical competence maintain healthcare team resilience.

There are several limitations to consider when interpreting the results of this study. First, the sample was obtained using purposive snowball sampling, which may have introduced sampling bias and may not accurately represent the larger population of healthcare team members who worked during the COVID-19, as 95% of the sample were white. Second, our study did not have equal representation of all interprofessional team members. It is possible that a more heterogenous sample regarding role, race and gender may have introduced additional codes. Additionally, the PI (JA) worked as a Certified Registered Nurse Anesthesiologist (CRNA) in acute care during the pandemic and personal experience may have introduced confirmation bias. Also, the focus of our research was to fill a gap in the existing knowledge of what is known about healthcare team resilience in pandemic disasters, and help to answer if and how it intersects with individual and organizational resilience. It is possible this novel conceptualization of healthcare team as a cohesive singular conscious source of knowledge did not adequately address this.

Steps to ensure rigor and mitigate any potential shortcomings of qualitative data analysis were the maintenance of a reflexive journal, a willingness of the PI to let go of unsupported ideas and constant verification of codes and themes with the research mentor (MN) for coherence and consistency within the coded data, selected methodology and research questions.

Overall, the extracted themes of teamwork in a pressure cooker; healthcare team cohesion; applying past lessons to present challenges; knowledge gaps; and altruistic behaviors illustrate comparable experiences within the healthcare team. As healthcare professionals and organizations continue to navigate the challenges of the COVID-19 pandemic and other crises, our findings provide valuable insights into how team cohesion, along with altruistic behaviors, may enhance resilience capabilities to create and maintain a unified resilient healthcare team.

Data availability

The data for this study are confidential as required by the IRB approval. To protect the anonymity of the participants, the data are not publicly available. Additional information about the research method, Interview questions, informant data, and the study in general can be requested from the corresponding author, J.A.

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Acknowledgements

The authors want to thank all the interviewed healthcare team participants for their time and sharing their personal stories and for their continued service during the COVID-19 pandemic. We would also like to acknowledge Ayaba Logan, the Research and Education Informationist, Mohan Madisetti, the MUSC College of Nursing Director of Research, the staff of the MUSC Center for Academic Excellence and the reviewers of this journal for their constructive criticism.

This research (software, transcription services, etc.) was solely funded by the Principal Investigator, J.A.

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John W. Ambrose, Lynne S. Nemeth, Diana M. Layne & Michelle Nichols

Department of Anesthesia and Perioperative Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA

Ken Catchpole

Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA

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Contributions

Conceptualization J.A., K.C., L.N., D.L., H.E., and M.N.; methodology J.A. and M.N.; J.A. led the study, recruited the interviewees, conducted interviews, led the data analysis, and drafted the manuscript. J.A., and M.N. conducted the data analyses; review and editing K.C., H.E., D.L., and M.N.; supervision M.N.; research project administration J.A. and M.N.; funding acquisition J.A. All authors reviewed the manuscript.

Corresponding author

Correspondence to John W. Ambrose .

Ethics declarations

Ethics approval and consent to participate.

This study presented no greater than minimal risk to participants and met exempt status per regulatory criteria established by 45 CFR 46.104 and 21 CFR 56.104. The study protocol and all materials were approved by the MUSC Institutional Review Board (IRB), [Pro00100917 ]. All study procedures were followed in accordance with these standards.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Ambrose, J.W., Catchpole, K., Evans, H.L. et al. Healthcare team resilience during COVID-19: a qualitative study. BMC Health Serv Res 24 , 459 (2024). https://doi.org/10.1186/s12913-024-10895-3

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Qualitative Methods in Health Care Research

Vishnu renjith.

School of Nursing and Midwifery, Royal College of Surgeons Ireland - Bahrain (RCSI Bahrain), Al Sayh Muharraq Governorate, Bahrain

Renjulal Yesodharan

1 Department of Mental Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Judith A. Noronha

2 Department of OBG Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Elissa Ladd

3 School of Nursing, MGH Institute of Health Professions, Boston, USA

Anice George

4 Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Healthcare research is a systematic inquiry intended to generate robust evidence about important issues in the fields of medicine and healthcare. Qualitative research has ample possibilities within the arena of healthcare research. This article aims to inform healthcare professionals regarding qualitative research, its significance, and applicability in the field of healthcare. A wide variety of phenomena that cannot be explained using the quantitative approach can be explored and conveyed using a qualitative method. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research. The greatest strength of the qualitative research approach lies in the richness and depth of the healthcare exploration and description it makes. In health research, these methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

Introduction

Healthcare research is a systematic inquiry intended to generate trustworthy evidence about issues in the field of medicine and healthcare. The three principal approaches to health research are the quantitative, the qualitative, and the mixed methods approach. The quantitative research method uses data, which are measures of values and counts and are often described using statistical methods which in turn aids the researcher to draw inferences. Qualitative research incorporates the recording, interpreting, and analyzing of non-numeric data with an attempt to uncover the deeper meanings of human experiences and behaviors. Mixed methods research, the third methodological approach, involves collection and analysis of both qualitative and quantitative information with an objective to solve different but related questions, or at times the same questions.[ 1 , 2 ]

In healthcare, qualitative research is widely used to understand patterns of health behaviors, describe lived experiences, develop behavioral theories, explore healthcare needs, and design interventions.[ 1 , 2 , 3 ] Because of its ample applications in healthcare, there has been a tremendous increase in the number of health research studies undertaken using qualitative methodology.[ 4 , 5 ] This article discusses qualitative research methods, their significance, and applicability in the arena of healthcare.

Qualitative Research

Diverse academic and non-academic disciplines utilize qualitative research as a method of inquiry to understand human behavior and experiences.[ 6 , 7 ] According to Munhall, “Qualitative research involves broadly stated questions about human experiences and realities, studied through sustained contact with the individual in their natural environments and producing rich, descriptive data that will help us to understand those individual's experiences.”[ 8 ]

Significance of Qualitative Research

The qualitative method of inquiry examines the 'how' and 'why' of decision making, rather than the 'when,' 'what,' and 'where.'[ 7 ] Unlike quantitative methods, the objective of qualitative inquiry is to explore, narrate, and explain the phenomena and make sense of the complex reality. Health interventions, explanatory health models, and medical-social theories could be developed as an outcome of qualitative research.[ 9 ] Understanding the richness and complexity of human behavior is the crux of qualitative research.

Differences between Quantitative and Qualitative Research

The quantitative and qualitative forms of inquiry vary based on their underlying objectives. They are in no way opposed to each other; instead, these two methods are like two sides of a coin. The critical differences between quantitative and qualitative research are summarized in Table 1 .[ 1 , 10 , 11 ]

Differences between quantitative and qualitative research

Qualitative Research Questions and Purpose Statements

Qualitative questions are exploratory and are open-ended. A well-formulated study question forms the basis for developing a protocol, guides the selection of design, and data collection methods. Qualitative research questions generally involve two parts, a central question and related subquestions. The central question is directed towards the primary phenomenon under study, whereas the subquestions explore the subareas of focus. It is advised not to have more than five to seven subquestions. A commonly used framework for designing a qualitative research question is the 'PCO framework' wherein, P stands for the population under study, C stands for the context of exploration, and O stands for the outcome/s of interest.[ 12 ] The PCO framework guides researchers in crafting a focused study question.

Example: In the question, “What are the experiences of mothers on parenting children with Thalassemia?”, the population is “mothers of children with Thalassemia,” the context is “parenting children with Thalassemia,” and the outcome of interest is “experiences.”

The purpose statement specifies the broad focus of the study, identifies the approach, and provides direction for the overall goal of the study. The major components of a purpose statement include the central phenomenon under investigation, the study design and the population of interest. Qualitative research does not require a-priori hypothesis.[ 13 , 14 , 15 ]

Example: Borimnejad et al . undertook a qualitative research on the lived experiences of women suffering from vitiligo. The purpose of this study was, “to explore lived experiences of women suffering from vitiligo using a hermeneutic phenomenological approach.” [ 16 ]

Review of the Literature

In quantitative research, the researchers do an extensive review of scientific literature prior to the commencement of the study. However, in qualitative research, only a minimal literature search is conducted at the beginning of the study. This is to ensure that the researcher is not influenced by the existing understanding of the phenomenon under the study. The minimal literature review will help the researchers to avoid the conceptual pollution of the phenomenon being studied. Nonetheless, an extensive review of the literature is conducted after data collection and analysis.[ 15 ]

Reflexivity

Reflexivity refers to critical self-appraisal about one's own biases, values, preferences, and preconceptions about the phenomenon under investigation. Maintaining a reflexive diary/journal is a widely recognized way to foster reflexivity. According to Creswell, “Reflexivity increases the credibility of the study by enhancing more neutral interpretations.”[ 7 ]

Types of Qualitative Research Designs

The qualitative research approach encompasses a wide array of research designs. The words such as types, traditions, designs, strategies of inquiry, varieties, and methods are used interchangeably. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research.[ 1 , 7 , 10 ]

Narrative research

Narrative research focuses on exploring the life of an individual and is ideally suited to tell the stories of individual experiences.[ 17 ] The purpose of narrative research is to utilize 'story telling' as a method in communicating an individual's experience to a larger audience.[ 18 ] The roots of narrative inquiry extend to humanities including anthropology, literature, psychology, education, history, and sociology. Narrative research encompasses the study of individual experiences and learning the significance of those experiences. The data collection procedures include mainly interviews, field notes, letters, photographs, diaries, and documents collected from one or more individuals. Data analysis involves the analysis of the stories or experiences through “re-storying of stories” and developing themes usually in chronological order of events. Rolls and Payne argued that narrative research is a valuable approach in health care research, to gain deeper insight into patient's experiences.[ 19 ]

Example: Karlsson et al . undertook a narrative inquiry to “explore how people with Alzheimer's disease present their life story.” Data were collected from nine participants. They were asked to describe about their life experiences from childhood to adulthood, then to current life and their views about the future life. [ 20 ]

Phenomenological research

Phenomenology is a philosophical tradition developed by German philosopher Edmond Husserl. His student Martin Heidegger did further developments in this methodology. It defines the 'essence' of individual's experiences regarding a certain phenomenon.[ 1 ] The methodology has its origin from philosophy, psychology, and education. The purpose of qualitative research is to understand the people's everyday life experiences and reduce it into the central meaning or the 'essence of the experience'.[ 21 , 22 ] The unit of analysis of phenomenology is the individuals who have had similar experiences of the phenomenon. Interviews with individuals are mainly considered for the data collection, though, documents and observations are also useful. Data analysis includes identification of significant meaning elements, textural description (what was experienced), structural description (how was it experienced), and description of 'essence' of experience.[ 1 , 7 , 21 ] The phenomenological approach is further divided into descriptive and interpretive phenomenology. Descriptive phenomenology focuses on the understanding of the essence of experiences and is best suited in situations that need to describe the lived phenomenon. Hermeneutic phenomenology or Interpretive phenomenology moves beyond the description to uncover the meanings that are not explicitly evident. The researcher tries to interpret the phenomenon, based on their judgment rather than just describing it.[ 7 , 21 , 22 , 23 , 24 ]

Example: A phenomenological study conducted by Cornelio et al . aimed at describing the lived experiences of mothers in parenting children with leukemia. Data from ten mothers were collected using in-depth semi-structured interviews and were analyzed using Husserl's method of phenomenology. Themes such as “pivotal moment in life”, “the experience of being with a seriously ill child”, “having to keep distance with the relatives”, “overcoming the financial and social commitments”, “responding to challenges”, “experience of faith as being key to survival”, “health concerns of the present and future”, and “optimism” were derived. The researchers reported the essence of the study as “chronic illness such as leukemia in children results in a negative impact on the child and on the mother.” [ 25 ]

Grounded Theory Research

Grounded theory has its base in sociology and propagated by two sociologists, Barney Glaser, and Anselm Strauss.[ 26 ] The primary purpose of grounded theory is to discover or generate theory in the context of the social process being studied. The major difference between grounded theory and other approaches lies in its emphasis on theory generation and development. The name grounded theory comes from its ability to induce a theory grounded in the reality of study participants.[ 7 , 27 ] Data collection in grounded theory research involves recording interviews from many individuals until data saturation. Constant comparative analysis, theoretical sampling, theoretical coding, and theoretical saturation are unique features of grounded theory research.[ 26 , 27 , 28 ] Data analysis includes analyzing data through 'open coding,' 'axial coding,' and 'selective coding.'[ 1 , 7 ] Open coding is the first level of abstraction, and it refers to the creation of a broad initial range of categories, axial coding is the procedure of understanding connections between the open codes, whereas selective coding relates to the process of connecting the axial codes to formulate a theory.[ 1 , 7 ] Results of the grounded theory analysis are supplemented with a visual representation of major constructs usually in the form of flow charts or framework diagrams. Quotations from the participants are used in a supportive capacity to substantiate the findings. Strauss and Corbin highlights that “the value of the grounded theory lies not only in its ability to generate a theory but also to ground that theory in the data.”[ 27 ]

Example: Williams et al . conducted a grounded theory research to explore the nature of relationship between the sense of self and the eating disorders. Data were collected form 11 women with a lifetime history of Anorexia Nervosa and were analyzed using the grounded theory methodology. Analysis led to the development of a theoretical framework on the nature of the relationship between the self and Anorexia Nervosa. [ 29 ]

Ethnographic research

Ethnography has its base in anthropology, where the anthropologists used it for understanding the culture-specific knowledge and behaviors. In health sciences research, ethnography focuses on narrating and interpreting the health behaviors of a culture-sharing group. 'Culture-sharing group' in an ethnography represents any 'group of people who share common meanings, customs or experiences.' In health research, it could be a group of physicians working in rural care, a group of medical students, or it could be a group of patients who receive home-based rehabilitation. To understand the cultural patterns, researchers primarily observe the individuals or group of individuals for a prolonged period of time.[ 1 , 7 , 30 ] The scope of ethnography can be broad or narrow depending on the aim. The study of more general cultural groups is termed as macro-ethnography, whereas micro-ethnography focuses on more narrowly defined cultures. Ethnography is usually conducted in a single setting. Ethnographers collect data using a variety of methods such as observation, interviews, audio-video records, and document reviews. A written report includes a detailed description of the culture sharing group with emic and etic perspectives. When the researcher reports the views of the participants it is called emic perspectives and when the researcher reports his or her views about the culture, the term is called etic.[ 7 ]

Example: The aim of the ethnographic study by LeBaron et al . was to explore the barriers to opioid availability and cancer pain management in India. The researchers collected data from fifty-nine participants using in-depth semi-structured interviews, participant observation, and document review. The researchers identified significant barriers by open coding and thematic analysis of the formal interview. [ 31 ]

Historical research

Historical research is the “systematic collection, critical evaluation, and interpretation of historical evidence”.[ 1 ] The purpose of historical research is to gain insights from the past and involves interpreting past events in the light of the present. The data for historical research are usually collected from primary and secondary sources. The primary source mainly includes diaries, first hand information, and writings. The secondary sources are textbooks, newspapers, second or third-hand accounts of historical events and medical/legal documents. The data gathered from these various sources are synthesized and reported as biographical narratives or developmental perspectives in chronological order. The ideas are interpreted in terms of the historical context and significance. The written report describes 'what happened', 'how it happened', 'why it happened', and its significance and implications to current clinical practice.[ 1 , 10 ]

Example: Lubold (2019) analyzed the breastfeeding trends in three countries (Sweden, Ireland, and the United States) using a historical qualitative method. Through analysis of historical data, the researcher found that strong family policies, adherence to international recommendations and adoption of baby-friendly hospital initiative could greatly enhance the breastfeeding rates. [ 32 ]

Case study research

Case study research focuses on the description and in-depth analysis of the case(s) or issues illustrated by the case(s). The design has its origin from psychology, law, and medicine. Case studies are best suited for the understanding of case(s), thus reducing the unit of analysis into studying an event, a program, an activity or an illness. Observations, one to one interviews, artifacts, and documents are used for collecting the data, and the analysis is done through the description of the case. From this, themes and cross-case themes are derived. A written case study report includes a detailed description of one or more cases.[ 7 , 10 ]

Example: Perceptions of poststroke sexuality in a woman of childbearing age was explored using a qualitative case study approach by Beal and Millenbrunch. Semi structured interview was conducted with a 36- year mother of two children with a history of Acute ischemic stroke. The data were analyzed using an inductive approach. The authors concluded that “stroke during childbearing years may affect a woman's perception of herself as a sexual being and her ability to carry out gender roles”. [ 33 ]

Sampling in Qualitative Research

Qualitative researchers widely use non-probability sampling techniques such as purposive sampling, convenience sampling, quota sampling, snowball sampling, homogeneous sampling, maximum variation sampling, extreme (deviant) case sampling, typical case sampling, and intensity sampling. The selection of a sampling technique depends on the nature and needs of the study.[ 34 , 35 , 36 , 37 , 38 , 39 , 40 ] The four widely used sampling techniques are convenience sampling, purposive sampling, snowball sampling, and intensity sampling.

Convenience sampling

It is otherwise called accidental sampling, where the researchers collect data from the subjects who are selected based on accessibility, geographical proximity, ease, speed, and or low cost.[ 34 ] Convenience sampling offers a significant benefit of convenience but often accompanies the issues of sample representation.

Purposive sampling

Purposive or purposeful sampling is a widely used sampling technique.[ 35 ] It involves identifying a population based on already established sampling criteria and then selecting subjects who fulfill that criteria to increase the credibility. However, choosing information-rich cases is the key to determine the power and logic of purposive sampling in a qualitative study.[ 1 ]

Snowball sampling

The method is also known as 'chain referral sampling' or 'network sampling.' The sampling starts by having a few initial participants, and the researcher relies on these early participants to identify additional study participants. It is best adopted when the researcher wishes to study the stigmatized group, or in cases, where findings of participants are likely to be difficult by ordinary means. Respondent ridden sampling is an improvised version of snowball sampling used to find out the participant from a hard-to-find or hard-to-study population.[ 37 , 38 ]

Intensity sampling

The process of identifying information-rich cases that manifest the phenomenon of interest is referred to as intensity sampling. It requires prior information, and considerable judgment about the phenomenon of interest and the researcher should do some preliminary investigations to determine the nature of the variation. Intensity sampling will be done once the researcher identifies the variation across the cases (extreme, average and intense) and picks the intense cases from them.[ 40 ]

Deciding the Sample Size

A-priori sample size calculation is not undertaken in the case of qualitative research. Researchers collect the data from as many participants as possible until they reach the point of data saturation. Data saturation or the point of redundancy is the stage where the researcher no longer sees or hears any new information. Data saturation gives the idea that the researcher has captured all possible information about the phenomenon of interest. Since no further information is being uncovered as redundancy is achieved, at this point the data collection can be stopped. The objective here is to get an overall picture of the chronicle of the phenomenon under the study rather than generalization.[ 1 , 7 , 41 ]

Data Collection in Qualitative Research

The various strategies used for data collection in qualitative research includes in-depth interviews (individual or group), focus group discussions (FGDs), participant observation, narrative life history, document analysis, audio materials, videos or video footage, text analysis, and simple observation. Among all these, the three popular methods are the FGDs, one to one in-depth interviews and the participant observation.

FGDs are useful in eliciting data from a group of individuals. They are normally built around a specific topic and are considered as the best approach to gather data on an entire range of responses to a topic.[ 42 Group size in an FGD ranges from 6 to 12. Depending upon the nature of participants, FGDs could be homogeneous or heterogeneous.[ 1 , 14 ] One to one in-depth interviews are best suited to obtain individuals' life histories, lived experiences, perceptions, and views, particularly while exporting topics of sensitive nature. In-depth interviews can be structured, unstructured, or semi-structured. However, semi-structured interviews are widely used in qualitative research. Participant observations are suitable for gathering data regarding naturally occurring behaviors.[ 1 ]

Data Analysis in Qualitative Research

Various strategies are employed by researchers to analyze data in qualitative research. Data analytic strategies differ according to the type of inquiry. A general content analysis approach is described herewith. Data analysis begins by transcription of the interview data. The researcher carefully reads data and gets a sense of the whole. Once the researcher is familiarized with the data, the researcher strives to identify small meaning units called the 'codes.' The codes are then grouped based on their shared concepts to form the primary categories. Based on the relationship between the primary categories, they are then clustered into secondary categories. The next step involves the identification of themes and interpretation to make meaning out of data. In the results section of the manuscript, the researcher describes the key findings/themes that emerged. The themes can be supported by participants' quotes. The analytical framework used should be explained in sufficient detail, and the analytic framework must be well referenced. The study findings are usually represented in a schematic form for better conceptualization.[ 1 , 7 ] Even though the overall analytical process remains the same across different qualitative designs, each design such as phenomenology, ethnography, and grounded theory has design specific analytical procedures, the details of which are out of the scope of this article.

Computer-Assisted Qualitative Data Analysis Software (CAQDAS)

Until recently, qualitative analysis was done either manually or with the help of a spreadsheet application. Currently, there are various software programs available which aid researchers to manage qualitative data. CAQDAS is basically data management tools and cannot analyze the qualitative data as it lacks the ability to think, reflect, and conceptualize. Nonetheless, CAQDAS helps researchers to manage, shape, and make sense of unstructured information. Open Code, MAXQDA, NVivo, Atlas.ti, and Hyper Research are some of the widely used qualitative data analysis software.[ 14 , 43 ]

Reporting Guidelines

Consolidated Criteria for Reporting Qualitative Research (COREQ) is the widely used reporting guideline for qualitative research. This 32-item checklist assists researchers in reporting all the major aspects related to the study. The three major domains of COREQ are the 'research team and reflexivity', 'study design', and 'analysis and findings'.[ 44 , 45 ]

Critical Appraisal of Qualitative Research

Various scales are available to critical appraisal of qualitative research. The widely used one is the Critical Appraisal Skills Program (CASP) Qualitative Checklist developed by CASP network, UK. This 10-item checklist evaluates the quality of the study under areas such as aims, methodology, research design, ethical considerations, data collection, data analysis, and findings.[ 46 ]

Ethical Issues in Qualitative Research

A qualitative study must be undertaken by grounding it in the principles of bioethics such as beneficence, non-maleficence, autonomy, and justice. Protecting the participants is of utmost importance, and the greatest care has to be taken while collecting data from a vulnerable research population. The researcher must respect individuals, families, and communities and must make sure that the participants are not identifiable by their quotations that the researchers include when publishing the data. Consent for audio/video recordings must be obtained. Approval to be in FGDs must be obtained from the participants. Researchers must ensure the confidentiality and anonymity of the transcripts/audio-video records/photographs/other data collected as a part of the study. The researchers must confirm their role as advocates and proceed in the best interest of all participants.[ 42 , 47 , 48 ]

Rigor in Qualitative Research

The demonstration of rigor or quality in the conduct of the study is essential for every research method. However, the criteria used to evaluate the rigor of quantitative studies are not be appropriate for qualitative methods. Lincoln and Guba (1985) first outlined the criteria for evaluating the qualitative research often referred to as “standards of trustworthiness of qualitative research”.[ 49 ] The four components of the criteria are credibility, transferability, dependability, and confirmability.

Credibility refers to confidence in the 'truth value' of the data and its interpretation. It is used to establish that the findings are true, credible and believable. Credibility is similar to the internal validity in quantitative research.[ 1 , 50 , 51 ] The second criterion to establish the trustworthiness of the qualitative research is transferability, Transferability refers to the degree to which the qualitative results are applicability to other settings, population or contexts. This is analogous to the external validity in quantitative research.[ 1 , 50 , 51 ] Lincoln and Guba recommend authors provide enough details so that the users will be able to evaluate the applicability of data in other contexts.[ 49 ] The criterion of dependability refers to the assumption of repeatability or replicability of the study findings and is similar to that of reliability in quantitative research. The dependability question is 'Whether the study findings be repeated of the study is replicated with the same (similar) cohort of participants, data coders, and context?'[ 1 , 50 , 51 ] Confirmability, the fourth criteria is analogous to the objectivity of the study and refers the degree to which the study findings could be confirmed or corroborated by others. To ensure confirmability the data should directly reflect the participants' experiences and not the bias, motivations, or imaginations of the inquirer.[ 1 , 50 , 51 ] Qualitative researchers should ensure that the study is conducted with enough rigor and should report the measures undertaken to enhance the trustworthiness of the study.

Conclusions

Qualitative research studies are being widely acknowledged and recognized in health care practice. This overview illustrates various qualitative methods and shows how these methods can be used to generate evidence that informs clinical practice. Qualitative research helps to understand the patterns of health behaviors, describe illness experiences, design health interventions, and develop healthcare theories. The ultimate strength of the qualitative research approach lies in the richness of the data and the descriptions and depth of exploration it makes. Hence, qualitative methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

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